Yuhua Ruan

Guangxi Medical University, Yung-ning, Guangxi Zhuangzu Zizhiqu, China

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Publications (107)355.25 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND The rapid growth of religious affiliations and ethnic minority populations in China has important implications for MSM sexual health and HIV risk. This qualitative study aims to elucidate HIV-relevant implications of ethnocultural affiliations among MSM in Beijing, China. METHODS Data were collected in 2013 by in-depth, semi-structured, face-to-face interviews with MSM residing in Beijing, China. Forty-one interviews were conducted with MSM from eleven ethnic groups, and included Buddhist, Christian, Muslim, and non-religious men. Verbatim Chinese interview transcripts were coded, verified, and analyzed thematically. RESULTS Muslim and Christian MSM discussed experiencing heightened mental distress and internalized homonegativity due to beliefs that homosexual sex contradicts the doctrines of their religion. Some religious respondents perceived HIV infection as supernatural retribution for an immoral lifestyle. Respondents discussed how religious beliefs informed decisions regarding sexual concurrency and anal/oral sex. Many Muslims were not circumcised and did not associate male circumcision with Muslim identity. Christians, Muslims, and ethnic Zhuang discussed avoiding sex with their religious or ethnic peers because it was perceived to be socially awkward. Ethnic Uyghur and Hui MSM discussed being adversely stereotyped because of ethnicity, while other respondents described Uyghur and Hui men as less than socially desirable. Christian respondents discussed how involvement with an LGBT Christian organization helped them mitigate and cope with mental stress as a Christian MSM. Numerous respondents discussed episodes of forced sex and unprotected anal intercourse. CONCLUSION Religious and ethnic identity pose important implications for understanding HIV risk among MSM in China and requires additional research.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Buprenorphine/naloxone (BUP/NX), an effective treatment for opioid dependence, has been implicated in hepatic toxicity. However, as persons taking BUP/NX have multiple hepatic risk factors, comparative data are needed to quantify the risk of hepatoxicity with BUP/NX.
    Drug and alcohol dependence. 06/2014;
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    ABSTRACT: Background: Compensatory mutations have been observed to emerge with drug resistance (DR) mutations, but their effects on virological response to treatment have not been fully examined. In this study, we characterized the emergence and depletion dynamics of a compensatory mutation K43E that correlated with primary nucleoside reverse transcriptase inhibitor (NRTI) drug resistance mutations in Chinese HIV patients on antiretroviral treatment. Method: Single Genome Amplification (SGA) was used to obtain the HIV-1 pol gene quasispecies in three patients over 6 years of Antiretroviral Therapy (ART) treatment. SGA sequences were analyzed by Markov Chain Monte Carlo (MCMC) phylogenetic trees with molecular clock to identify and track compensatory mutation K43E correlated with primary DR mutation M41L. We evaluated the relationship between potential compensatory mutation and DR mutations through Ka/Ks ratio, Jaccard similarity coefficient, and compared these with concurrent viral load data. Conclusion: We determined that a known compensatory mutation, K43E, frequently co-occurs with the drug resistance mutation M41L and may offer a significant advantage in the long-term survival of such drug resistant strains.
    Current HIV Research 06/2014; · 2.03 Impact Factor
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    ABSTRACT: To investigate the incidence of syphilis infection and to determine the risk factors related to syphilis infection among young men who had sex with men (YMSM), which were documented for developing effective intervention to prevent sexually transmitted diseases among YMSM.
    Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] 03/2014; 48(3):186-91.
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    ABSTRACT: Acceptability of pre-exposure prophylaxis (PrEP) and willingness to participate in a clinical trial for both safety and efficacy of PrEP were investigated among female sex workers (FSWs) in Guangxi, China. A cross-sectional study was performed in three cities in Guangxi. Structured, self-administered questionnaires were used to assess the acceptability of PrEP and the willingness to participate in a clinical trial. Multivariable logistic regression models were fitted to identify predictors. Among 405 participants, 15.1% had heard of PrEP. If PrEP was deemed to be effective, safe and provided for free, 85.9% reported that they would accept it, and 54.3% of those who accepted PrEP said that they would participate in a clinical trial. The increased acceptability of PrEP was associated with working in male dominated venues, higher income, a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, not being forced to use condoms by the gatekeepers, consistent use of condoms, and use of drugs to prevent STD infection. The increased willingness to participate in a clinical trial was associated with a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, a willingness to adhere to daily PreP use, and not being concerned about discrimination by others. The main reason for rejecting PrEP or participating in a clinical trial was the concern about the side effects of PrEP. Acceptability of PrEP among Guangxi FSWs is relatively high, indicating that PrEP intervention programs may be feasible for Chinese FSWs. Given the fact that most of the participants had never heard of PrEP before, and that family, gatekeepers, and social discrimination could significantly affect its acceptability, a comprehensive mix of multiple interventions is necessary for the successful implementation of a PrEP program among this population in Guangxi.
    PLoS ONE 01/2014; 9(1):e86200. · 3.53 Impact Factor
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    ABSTRACT: Prevention intervention trials have been conducted to reduce risk of sexual transmission among people living with HIV/AIDS (PLWHA), but the findings were inconsistent. We performed a systematic review and meta-analysis to evaluate overall efficacy of prevention interventions on unprotected vaginal or anal intercourse (UVAI) among PLWHA from randomized clinical trials (RCTs).
    PLoS ONE 01/2014; 9(9):e107652. · 3.53 Impact Factor
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    ABSTRACT: 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. Mathematical modeling. 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. The basic reproduction number based upon the current level of interventions is significantly higher than 1 ([Formula: see text] 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 ([Formula: see text]) for S1-S4 even with hyperbolic coverage in the sensitivity analysis, and is expected to decline ([Formula: see text]) for S5. 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.
    PLoS ONE 01/2014; 9(3):e90985. · 3.53 Impact Factor
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    ABSTRACT: Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2-15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services.
    BioMed research international. 01/2014; 2014:174870.
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    ABSTRACT: Objective. To evaluate HIV risk perception and its associated factors among Chinese MSM. Methods. A cross-sectional study was conducted among MSM with an HIV negative or unknown status in Beijing, China, between 2011 and 2012. A questionnaire interview was conducted and a blood sample was collected for HIV and syphilis testing. Results. Of 887 MSM who reported they were HIV negative or did not know their HIV status before recruitment, only 7.3% reported a high risk of HIV infection, 28.0% medium risk, 52.2% low risk, and 12.5% no risk. In multivariate logistic regression models using those who reported a medium self-perceived risk as a reference group, self-reported high risk of HIV perception was associated with minority ethnicity (odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.03-8.19), self-reported history of sexually transmitted diseases (OR: 2.27; 95% CI: 1.25-4.10), and HIV testing times since the last HIV testing (OR: 0.47; 95% CI: 0.26-0.84); low self-perceived risk of HIV infection was related to full-time employment (OR: 1.58; 95% CI: 1.15-2.18) and illicit drug use (OR: 0.28; 95% CI: 0.10-0.75). Conclusions. The HIV/AIDS epidemic is rapidly rising among Beijing MSM, but more than half MSM did not perceive this risk.
    BioMed research international. 01/2014; 2014:232451.
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    ABSTRACT: This study assessed the changes of HIV incidence and its predictors among Beijing's 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 Beijing's MSM. These findings underscored the urgency of scaling up effective and better-targeted intervention services to stop the rapid spread of the virus.
    BioMed research international. 01/2014; 2014:563517.
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    ABSTRACT: To conduct a systematic review and meta-analysis to evaluate the efficacy of peer-led interventions in reducing unprotected anal intercourse (UAI) among men who have sex with men (MSM). Randomized clinical trials (RCTs), quasi-experimental studies, pre- and post-intervention studies without control groups, and serial cross-sectional assessments involving peers delivering interventions among MSM and published as of February 2012 were identified by systematically searching 13 electronic databases and cross-referencing. Effect sizes (ES) were calculated as the changes of standardized mean difference (SMD) in UAI between groups or pre-post intervention. A total of 22 studies met the eligibility criteria, including five RCTs, six quasi-experimental studies, six pre-and-post intervention studies, and five serial cross-sectional intervention studies. We used 15 individual studies including 17 interventions for overall ES calculation; peer-led interventions reduced UAI with any sexual partners in meta-analysis (mean ES: -0.27; 95% confidence interval [CI]: -0.41, -0.13; P<0.01). Subgroup analyses demonstrated a statistically significant reduction on UAI in quasi-experimental studies (mean ES: -0.30; 95% CI: -0.50, -0.09; P = 0.01) and serial cross-sectional intervention studies (mean ES: -0.33; 95% CI: -0.57, -0.09; P = 0.01), but non-significant reduction in RCTs (mean ES: -0.15; 95% CI: -0.36, 0.07; P = 0.18) or pre- and post-intervention studies (mean ES: -0.29; 95% CI: -0.69, 0.11; P = 0.15). Heterogeneity was large across these 15 studies (I2 = 77.5%; P<0.01), largely due to pre-and-post intervention studies and serial cross-sectional intervention studies. Peer-led HIV prevention interventions reduced the overall UAI among MSM, but the efficacy varied by study design. More RCTs are needed to evaluate the effect of peer-led interventions while minimizing potential bias.
    PLoS ONE 01/2014; 9(3):e90788. · 3.53 Impact Factor
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    ABSTRACT: Objective. This is the first study in China to examine the use of nitrite inhalants and its correlates among men who have sex with men (MSM) in Beijing, China. Methods. A cross-sectional survey was conducted in 2012. Structured interviews collected data on demographics, sexual and drug use behaviors, and the use of HIV services. Blood specimens were collected and tested for HIV and syphilis. Results. A total of 400 MSM eligible for the study were between 19 and 63 years of age and overall HIV prevalence was 6.0% (9.0% among nitrite inhalant users and 3.3% among nonusers). Nearly half (47.3%) of them reported ever using nitrite inhalants and 42.3% admitted using nitrite inhalants in the past year. Multivariable logistic analysis revealed that ever using nitrite inhalants in the past was independently associated with being aged ≤25 years, having higher education attainment, seeking sex via Internet, having casual partners in the past three months, and being HIV positive. Conclusion. The use of nitrite inhalants was alarmingly prevalent among MSM in Beijing. The independent association of the nitrite inhalant use with more casual sex partners and HIV infection underscored the need for intervention and prevention of nitrite inhalant use.
    BioMed research international. 01/2014; 2014:365261.
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    ABSTRACT: Objectives. To figure out the most current prevalence of HIV and syphilis in MSM in China. Methods. A meta-analysis was conducted on the studies searched through PubMed, CNKI, and Wanfang published between 1 January 2009 and 11 April 2013. Results. Eighty-four eligible studies, either in Chinese or in English, were included in this review. The pooled prevalence of HIV and syphilis infection in MSM in China was 6.5% and 11.2%, respectively. The subgroup analyses indicated that the prevalence of HIV infection was higher in the economically less developed cities than that in the developed cities (7.5% versus 6.1%, P < 0.05). In contrast, the prevalence of syphilis infection was lower in less developed cities than in developed cities (8.6% versus 15.1%). Studies with a sample size smaller than 500 had a lower prevalence of HIV and syphilis infection than those with a sample size greater than 500 (5.9% versus 7.2% for HIV; 11.0% versus 11.5% for syphilis, respectively). Conclusions. HIV and syphilis infection are prevalent in MSM in China. The different prevalence of HIV and syphilis infection between developing and developed cities underscores the need to target prevention strategies based on economic conditions.
    BioMed Research International 01/2014; 2014:620431. · 2.71 Impact Factor
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    ABSTRACT: To explore HIV virological failure and drug resistance among injecting drug users (IDUs) receiving first-line antiretroviral treatment (ART) in China.
    BMJ Open 01/2014; 4(10):e005886. · 1.58 Impact Factor
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    ABSTRACT: To evaluate the impact of harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs) in a drug trafficking city in Southwest China. Before and after harm reduction program study. Two cross-sectional surveys were conducted among FSWs before and after harm reduction programs were launched in Xichang city, Sichuan province. The first and second cross-sectional surveys were conducted in 2004 and 2010, respectively. Temporal changes in odds of HIV, syphilis, and behavioral risk factors were assessed by multivariable logistic regression while controlling for socio-demographics. The 2004 and 2010 cross-sectional surveys recruited 343 and 404 FSWs, respectively. From 2004 to 2010, the odds of syphilis infection decreased by 35% and was of borderline statistical significance (AOR: 0.65, 95% CI: 0.41-1.03), while odds of HIV infection rose, but not significantly (AOR: 4.12, 95% CI: 0.76-22.45). Although odds of unprotected sex with primary sex partners did not significantly change over time (AOR: 0.96; 95% CI: 0.61-1.50), odds of unprotected sex with clients declined significantly and remarkably (AOR: 0.14, 95% CI: 0.09-0.21). Notably, the odds of reporting ≥10 new sex partners in the previous month increased by 37% (AOR: 1.37; 95% CI: 0.98-1.90). Harm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Future research is needed to better target both FSWs and IDUs and interrupt bridging networks for HIV transmission in high drug-using areas of China.
    PLoS ONE 01/2014; 9(1):e84950. · 3.53 Impact Factor
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    ABSTRACT: To determine the prevalence of virological failure and HIV drug resistance among Chinese patients one year after initiating lamivudine-based first-line antiretroviral treatment. A prospective cohort study with follow-up at 12 months was conducted in four urban sentinel sites in China. Antiretroviral naive patients ≥18 years old were recruited. Blood samples were collected for testing CD4 cell count, viral load, and (for samples with HIV-1 RNA ≥1000 copies/ml) genotyping of drug resistance. A total of 513 patients were enrolled in this cohort, of whom 448 (87.3%) were retained at 12 months. The median final CD4 cell count was 313 cells/mm(3), which increased from 192 cells/mm(3) at baseline (P<0.0001). Of the 448 remaining subjects, 394 (87.9%) had successful virological suppression (HIV RNA <1000 copies/ml). Among 54 samples with viral load ≥1000 copies/ml, 40 were successfully genotyped, and 11 were found with detectable HIV drug resistance mutations. Of these, the proportions of drug resistance to NNRTIs, NRTIs and PIs were 100%, 81.8% and 0%, respectively. Injecting drug use (AOR = 0.40, 95% CI: 0.19,0.84; P = 0.0154), CD4 count at baseline ≥350 cells/mm(3) (AOR = 0.32, 95% CI: 0.14,0.72; P = 0.0056), and missed doses in the past month (AOR = 0.30, 95% CI: 0.15,0.60; P = 0.0006) were significantly negatively associated with HIV RNA <1000 copies/ml. Our study demonstrates effective virological and immunological outcomes at 12 months among these who initiated first-line ART treatment. However, patients infected through drug injection, who missed doses, or with higher CD4 count at baseline are at increased risk for poor virological response.
    PLoS ONE 01/2014; 9(2):e88305. · 3.53 Impact Factor
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    ABSTRACT: The HIV/AIDS epidemic among Chinese men who have sex with men (MSM) has become a significant public health concern. Knowledge of alcohol consumption in this population is limited. In this study, 1,155 Chinese MSM were surveyed to assess alcohol use and its correlates. A meta-analysis was also performed to aggregate pooled prevalence of current alcohol use. MSM who were unmarried (aOR: 1.87; 95% CI: 1.29-2.71) or unemployed/retired (aOR: 2.77; 95% CI: 1.73-4.45) were more likely to drink alcohol more than once per week. MSM who consumed alcohol more than once per week were more likely to use drug (P < 0.01), have sex with women (P < 0.01), have unprotected insertive (P = 0.04) or receptive (P = 0.03) anal sex with men, have more than 10 lifetime male sex partners (P < 0.01), predominantly practice insertive anal sex (P < 0.01), and trade sex for money (P < 0.01). Pooled overall alcohol use prevalence was 32%. Pooled prevalence for MSM who drank alcohol more than once per week and who drank alcohol before sex with male partners was 23%. Our findings provide the basis for further exploring the alcohol-HIV association and developing risk reduction interventions.
    BioMed research international. 01/2014; 2014:414381.
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    ABSTRACT: We determined the prevalence and incidence of HBV and HCV infection in people who inject drugs (PWIDs) at high risk for HIV in China and Thailand and determined the association of HBV and HCV incidence with urine opiate test results and with short-term versus long-term buprenorphine-naloxone (B-N) treatment use in a randomized clinical trial (HPTN 058). 13.8% of 1049 PWIDs in China and 13.9% of 201 PWIDs in Thailand were HBsAg positive at baseline. Among HBsAg negative participants, the HBsAg incidence rate was 2.7/100 person years in China and 0/100 person years in Thailand. 81.9% of 1049 PWIDs in China and 59.7% of 201 in Thailand were HCV antibody positive at baseline. The HCV confirmed seroincidence rate among HCV antibody negative PWIDs was 22/100 person years in China and 4.6/100 person years in Thailand. Incident HBsAg was not significantly different in the short-term versus long-term B-N arm in China or Thailand. Participants with positive opiate results in at least 75% of their urines during the time period were at increased risk of incident HBsAg (HR = 5.22; 95% CI, 1.08 to 25.22; P = 0.04) in China, but not incident HCV conversion in China or Thailand.
    Hepatitis research and treatment 01/2014; 2014:296958.
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    ABSTRACT: During the early mid-1990s, a number of rural farmers across central China were employed to the unregulated plasma-selling-activity and many of them were infected by HIV-1. However, AIDS progression in the former blood donors (FBDs) is various. The aim of this study is to assess human leukocyte antigen (HLA) class I allele distribution in FBDs and evaluate its association with HIV-1 infection and disease progression. A total of 353 FBDs were enrolled in the cohort including 294 ART naïve HIV-1 seropositive and 59 HIV-1 seronegative age-matched subjects. The viral load and CD4/CD8 T cell counts were assessed in all subjects. Compared with HIV-seropositive group, the frequency of HLA-A*03 in control was significantly higher. After classifying the HLA-B alleles of the subjects according to the presence of Bw4/Bw6 serological epitopes, detrimental effect of HLA Bw6/ Bw6 homozygosity was also confirmed in the HIV-seropositive subjects. This study provides novel evidence on HLA class I allele distribution and association of HLA-A*03 frequency with HIV-1 infection and viremia in the HIV-1 infected former blood donors, which may throw light on intervention strategy for the HIV-1 infection and our understanding how host immunity and genetic background affect HIV infection and AIDS progression.
    Science China. Life sciences 10/2013; · 2.02 Impact Factor
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    ABSTRACT: Few studies have examined coercive sex and HIV vulnerabilities among men who have sex with men (MSM) in China. The present study seeks to compare individual characteristics between MSM who did and did not experience coercive sex at their MSM sexual debut and to identify HIV risk factors correlated with coercive sex at MSM sexual debut. In 2007, we recruited 167 MSM in Beijing, China by peer-referred social network sampling. Each participant then completed self-administered questionnaires regarding their sexual experiences and practices. Results show that 14% of participants reported coercive sex at MSM sexual debut, of whom 48% reported recent unprotected anal intercourse (UAI). Coercive sex at MSM sexual debut was significantly associated with UAI [adjusted odds ratio (AOR): 5.38, 95% confidence interval: 1.95-14.87] and lifetime number of male sex partners (AOR: 7.25, 95% CI: 2.39-22.01). Coercive sex is harming MSM in China and should be immediately addressed by researchers, public health officials, and MSM community stakeholders.
    AIDS Care 10/2013; · 1.60 Impact Factor

Publication Stats

892 Citations
355.25 Total Impact Points


  • 2013
    • Guangxi Medical University
      • School of Public Health
      Yung-ning, Guangxi Zhuangzu Zizhiqu, China
  • 2012
    • University of Jinan (Jinan, China)
      Chi-nan-shih, Shandong Sheng, China
    • Vanderbilt University
      • Vanderbilt Institute for Global Health
      Nashville, MI, United States
    • Chongqing Center for Disease Control and Prevention
      Ch’ung-ch’ing-shih, Chongqing Shi, China
  • 2007–2012
    • Beijing Centers for Disease Control and Prevention
      Peping, Beijing, China
    • State Key Laboratory of Medical Genetics of China
      Ch’ang-sha-shih, Hunan, China
  • 2004–2012
    • Chinese Center For Disease Control And Prevention
      • National Center for AIDS/STD Control and Prevention
      Beijing, Beijing Shi, China
  • 2009
    • Shanghai University
      • Department of Mathematics
      Shanghai, Shanghai Shi, China
  • 2008
    • University of Alabama at Birmingham
      • Division of Preventive Medicine
      Birmingham, AL, United States