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Proportions of HIV testing frequency in the past 12 months among five key populations in China. Total N = 2022, 737 (36.4%) did not take an HIV testing, 746 (36.9%) tested only once, and 533 (26.4%) took two or more testing in the past year. There are 3 missing values of HIV testing frequency for PWUD and SNPs respectively. The error bars represent the 95% confidence intervals. MSM men who have sex with men, FSW female sex worker, PWUD people who use drugs; MCSW men who have casual sex with women, SNP sero-negative partner among sero-discordant couples
Source publication
Background
Regular HIV testing is the best way to detect people living with HIV promptly, yet not much is known about the characteristics of frequent, voluntary testers. This study explores factors related to HIV testing frequency among five key populations in China including men who have sex with men (MSM), female sex workers (FSWs), people who us...
Citations
... As found, individuals with a high school education or higher were twice as likely to be found as recent infections than those who were no formal education (AOR = 2.04, 95% CI: 1.24-3.37). Based on the associated studies, we speculated that the lower proportion of recent infections among individuals with low education may be related to their lack of awareness of HIV testing, while the high proportion of recent infections among individuals highly educated may be related to their greater awareness of HIV testing and high level of knowledge about HIV/AIDS prevention and control [27,28]. These differences indicate a need to consider strengthening AIDS promotion and education tailored to people with different levels of education. ...
Background
Honghe Prefecture, located on the China-Vietnam border, has long suffered from HIV-1. To accurately assess the HIV-1 prevalence situation and promote precise prevention and treatment of AIDS, a recent infection surveillance was conducted to explore the at-risk subpopulations and hotspot areas of HIV-1 transmission in Honghe Prefecture.
Methods
Combined with the recent infection testing algorithm, HIV-1 recency assay was used to differentiate recent HIV-1 infections among newly reported HIV-1 cases in Honghe Prefecture from 2021 to 2022. Factors associated with recent HIV-1 infection were analyzed by logistic regression. The hotspot areas of recent infections were analyzed by spatial scanning statistics.
Results
Of the 2698 HIV-1-infected individuals enrolled in this study (no HIV-2 cases reported), 297 HIV-1 cases were classified as recent HIV-1 infection, and the proportion of recent infection was 11.0%. Females (AOR = 2.61, 95% CI: 1.98–3.43), young people (15–34 years old) (AOR = 1.71, 95% CI: 1.21–2.43), highly educated people (AOR = 2.04, 95% CI: 1.24–3.37), men who have sex with men (MSM) (AOR = 3.08, 95% CI: 1.74–5.46), and spouses/regular sexual partners of HIV-1-positive individuals (AOR = 1.96, 95% CI: 1.15–3.33) were more likely to be detected as recent infections. Among the subpopulations by sex, age and transmission route, heterosexually exposed women aged 15–34 years (OR = 1.85, 95% CI: 1.07–3.19) and 35–49 years (OR = 1.65, 95% CI: 1.05–2.58) and MSM aged 15–34 years (OR = 5.11, 95% CI: 2.73–9.59) had a higher proportion of recent infections. Among the subpopulations by mode of exposure and sex, men infected through homosexual contact (OR = 5.59, 95% CI: 3.30–9.47) and women infected through non-marital non-commercial heterosexual contact (OR = 2.10, 95% CI: 1.50–2.95) and positive spousal exposure (OR = 3.03, 95% CI: 1.96–4.69) had a higher proportion of recent infections. With regard to detection methods, women detected by provider-initiated HIV testing counseling (PITC) (OR = 2.03, 95% CI: 1.50–2.76) and spouse/sexual partner testing (OR = 4.10, 95% CI: 2.19–7.67) had a higher proportion of recent infections. A statistically significant spatial cluster of recent infections was found in one county, Yuanyang.
Conclusions
This study investigated the use of HIV-1 recency testing in combination with HIV-1 case report surveillance. Correlation factor analysis revealed the presence of distinct risk subpopulations. The spatial distribution of recent infections showed differences. These findings were important for assessing the transmission risk and developing the targeted measures for interventions.
Clinical trial number
Not applicable.
... We found that educational attainment is a critical factor in uencing HIV infection among MSM. Multiple studies have con rmed that MSM with higher educational levels are more likely to avoid high-risk behaviors (24)(25). In this study, lower educational attainment was associated with more frequent smoking behaviors and higher frequencies of sexual activities (p < 0.05). ...
Background
Compared to the overall decrease in infection rates, the prevalence of HIV among key populations like men who have sex with men (MSM) remains high. Understanding the factors influencing HIV in these key populations is crucial. However, currently there are few large-scale studies that can comprehensively incorporate multiple potential influencing factors. Therefore, it is significant to build a predictive model for HIV infection among MSM based on demographic, behavioral, social and psychological characteristics.
Methods
A cross-sectional study of MSM was conducted in six major regions of China. Data were collected through face-to-face interviews. We screen variables through univariate and multivariate analyses, and construct a predictive model through stepwise regression. We evaluated the model through nomograms, ROC(Receiver Operating Characteristic) curves and decision curve analysis (DCA).
Results
Among 2,403 MSM, 199 were HIV positive, resulting in a prevalence rate of 8.3%. MSM aged 35–44, with lower education level, higher smoking frequency, having STDs, assuming the receptive role in same-sex intercourse, using drugs before sex and experiencing depression are more likely to be infected with HIV. The Hosmer-Lemeshow test showed a p-value of 0.3834 for the model. The AUC of the nomogram was 0.783 (95% CI: 0.749–0.816).
Conclusions
HIV infection among the MSM population arises from a combination of demographic, behavioral, social and psychological characteristics. The development of the predictive model aids in formulating targeted and comprehensive intervention strategies. We need to strengthen our focus on HIV infection in MSM and take targeted measures based on the results of predictive model to curb the spread of HIV.
... In addition, evidences have proved that peer education has a good effect on boosting HIV testing and reduce the risk of HIV infections [18][19][20][21]. [22,23]. Second, offering testing to MSM through effective strategies is necessary to discover the HIV positive MSM. ...
Background: A regular human immunodeficiency virus (HIV) testing with a safe sexual behavior is an important preventive strategy in the control of HIV especially among men who have sex with men (MSM), who are in risk of HIV infection. Therefore, we aim to explore the reasons boosting HIV testing among MSM and the risky sexual behaviors behind.
Methods: An institutional based investigationwas conducted to collect data from MSM in January and December 2022in Zhejiang Coastal Public Welfare Center which is a non-government organization (NGO). The risky sexual behaviors included commercial sexual behaviors, unprotected sexual behaviors, multiple sexual partners, drug using and using sexual stimulant. The reasons for boosting MSM to have HIV testing included prevention before/after exposure, regular habit testing high risk post testing, peer driven testing, publicity and education testing and others. The factors influencing the unprotected sex, multiple sexual partners, using drugs and sexual stimulants of MSM were explored based on multivariate logistic regression.
Results:In total, 7266 MSM were incorporated in the analysis. The most important reason for boosting MSM to have an HIV testing were their regular habit testing(51.73%) followed by high risk post test (15.99%), publicity and education testing(12.72%). The population who had high risk post HIV test had the highest percentage of unprotected sex(78.83%), commercial sex(0.84%), using drugs(4.22%) and sexual stimulant(42.0%), multiple sexual partners(30.98%) and symptoms or diagnosis of sexual transmitted diseases (6.11%) compared with MSM with other HIV testing reasons respectively. Compared with the reasons for HIV testing of prevention before/after exposure, people with high-risk post testing had a higher probability of having unprotected sex (P<0.001, OR=5.804) and multiple sexual partners (P=0.041, OR=1.476). Publicity and education testing had a lower probability of having unprotected sex (P<0.001, OR=0.432) and multiple sexual partners (P=0.006, OR=0.575).
Conclusions: Reasons for boosting HIV testing among MSM were different with different risky sexual behaviors, and the rate of having risky sexual behaviors among MSM with regular HIV testing habits was lower. However, most MSM have not developed the habit of regular HIV testing. Therefore, improving the HIV testing among MSM is still important to reduce the transmission of HIV.
... First, the Chinese government adopted a policy of expanding testing in recent years, which has significantly improved the detection rate of the virus. This indicates that the expanded testing policy was widely implemented, leading to more HIV/AIDS being detected [19]. Second, at the beginning of the pandemic, HIV/AIDS mainly affected young individuals [20]; therefore, most education catered to that age group, while older individuals were overlooked, which increases their risk of infection in that age group. ...
... The period effect of newly reported HIV infections among older adults in the Zhejiang Province from 2004 to 2021 was consistent with the change in the Joinpoint regression. The monotonic upward trend in the period effect of newly reported infections was associated with factors such as policies to expand testing and unsafe sex among older adults [8,19,21]. Period effects are an important factor influencing HIV/AIDS transmission among older adults and is linked to medical advances and policy development. As economies and societies advance, multidisciplinary approaches to curb growing HIV/AIDS-related problems must be considered. ...
Background
In recent years, the number and proportion of newly reported HIV/AIDS cases among older adults have increased dramatically. However, research on the pattern of temporal and spatial changes in newly reported HIV/AIDS among older adults remains limited.
Objective
This study analyzed the spatial and temporal distribution of HIV/AIDS cases and its influencing factors among older adults in Eastern China from 2004 to 2021, with the goal of improving HIV/AIDS prevention and intervention.
Methods
We extracted data on newly reported HIV/AIDS cases between 2004 and 2021 from a case-reporting system and used a Joinpoint regression model and an age-period-cohort model to analyze the temporal trends in HIV/AIDS prevalence. Spatial autocorrelation and geographically weighted regression models were used for spatial aggregation and influence factor analysis.
Results
A total of 12,376 participants with HIV/AIDS were included in the study. The newly reported HIV infections among older adults increased from 0.13 cases per 100,000 people in 2004 to 7.00 cases per 100,000 people in 2021. The average annual percent change in newly reported HIV infections was 28.0% (95% CI –21.6% to 34.8%). The results of the age-period-cohort model showed that age, period, and cohort factors affected the newly reported HIV infections among older adults. The newly reported HIV/AIDS cases among men who have sex with men (MSM) had spatial clustering, and the hotspots were mainly concentrated in Hangzhou. The disposable income of urban residents, illiteracy rate among people aged 15 years or older, and number of hospital beds per 1000 residents showed a positive association with the newly reported HIV infections among older MSM in the Zhejiang province.
Conclusions
HIV/AIDS among older adults showed an increasing trend and was influenced by age, period, and cohort effects. Older MSM with HIV/AIDS showed regional clustering and was associated with factors such as the disposable income of urban residents, the illiteracy rate among people aged 15 years or older, and the number of hospital beds per 1000 people. Targeted prevention and control measures are needed to reduce HIV infection among those at higher risk.
... When high-risk sexual behavior occurs, nonfirst-time testers can take the initiative to take HIV testing and counseling [28]. Meanwhile, MSM who were highly educated and earned a relatively high-income had greater health awareness [29,30]. However, most first-time testers had a high income and were less willing to participate in HIV testing in the future compared to non-first-time testers. ...
HIV self-testing (HIVST) is an effective method to expand HIV testing coverage worldwide. We analyze the results of HIVST and sexual behaviors of first-time testers among Men who have sex with men (MSM) who participated in a secondary distribution of HIVST kits. A total of 589 participants were recruited, including 173 first-time testers and 416 non-first-time testers. The first-time testers were mainly of Han ethnicity (aOR 1.88, 95% CI 1.10, 3.24), more likely to be HIV positive (aOR 7.18, 95% CI 2.37, 21.72), and had higher income (aOR 2.01, 95% CI 1.10, 3.69). Both groups were less likely to have anal sex with male partners (χ²: 146.24, P < 0.01), (χ²: 582.72, P < 0.01) or have sex with female partners (χ²: 19.01, P < 0.01), (χ²: 35.74, P < 0.01) after HIVST. We should expand HIVST among MSM and other key populations to identify first-time testers.
... 22 It is possible that GBMSM in our study were more likely to have a higher educational level and income level, and be employed, which were found to be predictors of HIV testing in recent studies. [23][24][25] However, younger GBMSM in our sample were more likely to receive a recent HIV test, which was different than previous findings. 23,26 One possible explanation is that younger GBMSM were more likely to engage in social media and internet use during the quarantine. ...
The COVID-19 pandemic has created additional barriers to accessing sexual health services among gay, bisexual, and other men who have sex with men (GBMSM) in China. Yet, little is known about the frequency of HIV testing and how GBMSM get tested during the pandemic. We surveyed an online sample of GBMSM recruited on a gay networking app in China. Among 956 sexually active, 70.1% had received an HIV test in the past 6 months. Among these, 61.0% reported having undergone HIV self-testing (HIVST). Young GBMSM aged 18-24 years old were more likely to receive a recent HIV test, and the number of sexual partners was associated with recent HIV testing [adjusted odds ratio (AOR) = 1.14, 95% confidence interval (CI): 1.03-1.20]. Among those who had a recent HIV test, young GBMSM and those who had anal sex with both main partner and casual partners were more likely to utilize HIVST (AOR = 1.83, 95% CI: 1.16-2.84), as well as GBMSM who did not use a condom the last time engaged in anal sex (AOR = 1.57, 95% CI: 1.06-2.34). Among GBMSM never tested for HIV, a majority perceived low risk of HIV, while some suggested that they did not know where to get tested or they were scared of finding out they had HIV. HIVST has the potential to fill the gap in HIV testing among Chinese GBMSM, and future HIV testing programs should emphasize HIV education, accurate information dissertation, and timely point-to-care services.
... In the one hand, the less educated IMMSM usually have less chance to obtain health information and support (2), which may lead to their poorer abilities on protecting themselves from HIV infection. In the other hand, ADDIN EN.CITE (54,55) some studies found that condom use frequencies as well as the number of consistent sexual partner were significantly higher among MSM with higher levels of education (e.g., college students or teachers) than among others (56)(57)(58), which suggested that low HIV infection risk in more educated IMMSM may benefits from their low participation in risky sexual behaviors. ...
Introduction
Internal migrant Men who have sex with men (IMMSM), which has the dual identity of MSM and floating population, should be more concerned among the vulnerable groups for HIV in society. Establishing appropriate prediction models to assess the risk of HIV infection among IMMSM is of great significance to against HIV infection and transmission.
Methods
HIV and syphilis infection were detected using rapid test kits, and other 30 variables were collected among IMMSM through questionnaire. Taking HIV infection status as the dependent variable, three methods were used to screen predictors and three prediction models were developed respectively. The Hosmer-Lemeshow test was performed to verify the fit of the models, and the net classification improvement and integrated discrimination improvement were used to compare these models to determine the optimal model. Based on the optimal model, a prediction nomogram was developed as an instrument to assess the risk of HIV infection among IMMSM. To quantify the predictive ability of the nomogram, the C-index measurement was performed, and internal validation was performed using bootstrap method. The receiver operating characteristic (ROC) curve, calibration plot and dynamic component analysis (DCA) were respectively performed to assess the efficacy, accuracy and clinical utility of the prediction nomogram.
Results
In this study, 12.52% IMMSMs were tested HIV-positive and 8.0% IMMSMs were tested syphilis-positive. Model A, model B, and model C fitted well, and model B was the optimal model. A nomogram was developed based on the model B. The C-index of the nomogram was 0.757 (95% CI: 0.701–0.812), and the C-index of internal verification was 0.705.
Conclusions
The model established by stepwise selection methods incorporating 11 risk factors (age, education, marriage, monthly income, verbal violence, syphilis, score of CUSS, score of RSES, score of ULS, score of ES and score of DS) was the optimal model that achieved the best predictive power. The risk nomogram based on the optimal model had relatively good efficacy, accuracy and clinical utility in identifying internal migrant MSM at high-risk for HIV infection, which is helpful for developing targeted intervention for them.
Background
This study aimed to assess the trends and determine the factors associated with late presentation (LP) and advanced HIV disease (AHD) among newly diagnosed people living with HIV (PLWH) from 2008 to 2020 in Jiangsu, China.
Methods
Newly diagnosed PLWH registered in the HIV surveillance system from 2008 to 2020 were included. Multivariable logistic regression models were used to analyze the factors associated with LP and AHD. The LP and AHD trends were assessed using Joint-point analysis.
Results
Of 37,251 newly diagnosed PLWH identified, 30,251(81.2%) patients met the inclusion criteria. Among those, 16,672 (55.1%) were considered LP, and 8,691 (28.7%) had AHD. LP trends steadily increased from 2008 (39.0%) to 2020 (59.4%), but AHD trends decreased visibly from 2016 (32.3%) to 2020 (23.4%). The overall median CD4 trends decreased slowly from 389 to 305 cells/mm³ between 2008 and 2020. Married patients and those older than 35 years were more likely to be LP and have AHD. Patients infected via heterosexual transmission had a higher risk of being classified as AHD (aOR: 1.13, 95%CI: 1.06–1.21) than patients infected via homosexual transmission. Patients that were diagnosed at sexually transmitted infections (STIs) clinics (aOR: 1.10, 95%CI: 1.01–1.20) and in hospitals (aOR: 1.69, 95%CI: 1.59–1.79) were more likely to be classified as LP compared with patients diagnosed at voluntary counseling and testing (VCT) centers. Similar, patients diagnosed at STIs clinics (aOR: 1.23, 95%CI: 1.11–1.36) and hospitals (aOR: 2.27, 95%CI: 2.12–2.43) were more likely to have AHD than patients diagnosed in VCT.
Conclusion
Our findings indicate an alarming burden of LP in Jiangsu, suggesting the need for more attention toward HIV diagnosis at early CD4 stages. National HIV control programs must strengthen comprehensive interventions for HIV prevention and promote HIV services. Also, strategies for HIV prevention (PrEP and PEP), testing, and treatment must be extended, especially among the general population.
Background
Female sex workers (FSWs) are considered highly vulnerable to sexually transmitted infections (STIs), but available data on the prevalence of STIs among FSWs in China is limited at a provincial level. This study aimed to evaluate the prevalence of STIs and risk factors among FSWs in Jiangsu, China.
Methods
We conducted a multicenter cross-sectional study in seven cities of Jiangsu to investigate the prevalence and risk factors associated with HIV and other STIs. Blood and urine were collected to test for HIV, syphilis, Hepatitis C (HCV), Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.
Results
We enrolled 3,580 FSWs. The overall prevalence of bacterial STIs was 6.2% (5.4%−7.0%). The prevalence of HIV, syphilis infection, HCV, NG and CT were 0.1% (95%CI, 0.0–0.2), 1.8% (95%CI, 1.4–2.3), 0.3% (95%CI, 0.1–0.5), 0.3% (95%CI, 0.2–0.5) and 4.3% (95%CI, 3.6–5.0), respectively. Most FSWs (85.6%) reported consistent condom use with clients in the past month. Only 10.6% of FSWs reported group sex, and 68.3% self–reported HIV testing in the previous year. According to the multivariable model, having group sex in the past year (aOR, 2.521, 95%CI: 1.366–4.651) and HIV infection (aOR, 26.260, 95%CI: 2.432–283.563) were associated with a higher risk of syphilis infection. Migrants (aOR, 1.669, 95%CI: 1.163–2.395), having a history of STIs in the past year (aOR, 4.601, 95%CI: 1.003–21.118), and NG infection (aOR, 38.549, 95%CI: 11.214–132.514) were associated with a higher risk of CT infection. On the contrary, FSWs aged older than 25 were associated with lower risk of syphilis infection (25–34: aOR, 0.339, 95%CI: 0.151–0.763) and CT infection (25–34: aOR, 0.503, 95%CI: 0.316–0.802; ≥35: aOR, 0.578, 95%CI: 0.362–0.925).
Conclusion
This study's prevalence rates of syphilis and CT infections show the need to promote comprehensive STIs control and prevention strategies, including behavioral intervention and STIs screening, especially in younger high–risk populations. With the increasing coverage of HIV testing, integrating other STIs screening with HIV testing may be a reasonable way to implement comprehensive STIs control and prevention.
