Zhihuan Jennifer Huang

Introduction People living with HIV relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known on the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns. Methods A mixed methods study was conducted among 29 CBOs serving PLHIV in China between November 10 and November 23, 2020. Participants were asked to complete a 20-minute online survey on their routine operations, organizational capacity building, service provided, and challenges during the pandemic. A focus group interview was conducted with CBOs after the survey to gain further insights on data interpretations. Quantitative data analysis was conducted using STATA 17.0 while qualitative data was examined using thematic analysis. Results HIV-focused CBOs in China serve diverse clients including PLHIV, high-risk groups, and the general public. The scope of services provided is broad, ranging from HIV testing to peer support. All CBOs maintained their services during the pandemic, many by switching to online or hybrid mode. Many CBOs reported adding new clients and services, such as mailing medications. Top challenges faced by CBOs included service reduction due to staff shortage, lack of PPE for staff, and lack of funding during COVID-19 lockdowns. In addition to the staff and funding needs, the ability to better network with other CBOs and other sectors (e.g., clinics, governments), a standard emergency response guideline, and ready strategies to help PLHIV build resilience are critical for future emergency preparation. Conclusions Chinese CBOs serving vulnerable populations affected by HIV/AIDS are instrumental in building resilience in their communities during the COVID-19 pandemic, and they can play significant roles in providing uninterrupted services during emergencies by mobilizing resources, creating new services and operation methods, and utilizing existing networks. Chinese CBOs’ experiences, challenges, and their policy recommendations can inform policy makers on how to support future CBO capacity building to bridge service gaps during crises and reduce health inequalities in China and globally.

Globally, female street-based sex workers are vulnerable to gender-based violence. Previous research has shown having a peer social network can reduce sex workers’ risks of victimization. However, mechanisms of how social network impacts violence among female street-based sex workers are still far from clear. Our study was based on data abstracted from a paper-and-pencil survey administered among 218 female street-based sex workers in Shanghai, China. We focused on self-reported client-initiated violence and intimate-partner violence in emotional, physical, and sexual forms. Social networks were characterized by the size and sources of financial and psychosocial support (e.g. family, friends, and peers). Multi-variable logistic regression was used to estimate adjusted odds ratios (AOR) of each type of violence exposure by social network structure after the adjustment of age, education, and years in Shanghai. The street-based female sex workers in our study were primarily rural-to-urban migrants (95.7%) with an average age of 41 years old. 24.3% and 62.8% of the sex workers reported intimate-partner violence and client-initiated violence respectively. Lack of financial support, as defined by having only one individual or none in her peer support system to help financially, was significantly associated with self-reported intimate-partner violence (AOR: 2.5; 95% CI: 1.1–5.9). Respondents who reported client-initiated violence, by contrast, were more likely to report lacked psychosocial support from family (AOR: 2.2, 95% CI: 1.0–4.6) and peers (AOR: 5.1, 95% CI: 2.2–11). This study is one of the first to systematically analyze the associations between social network and gender-based violence among street-based female sex worker. We reported a high prevalence of both types of gender-based violence and their complex associations with family, friends, and peer support network. Policies with goals to reduce violence against women may apply these findings to leverage social network in the interventions against gender-based violence.

Objectives . We examined associations between generational status and age-adjusted type 2 diabetes (T2DM) among Asians living in California. Methods . We abstracted data on 7,188 Asian Americans of six ethnicities from the 2007 and 2009 California Health Interview Survey. Age-and ethnicity-specific logistic regression analyses were used to model prevalence of T2DM based on 29 generational status and language spoken at home. Results . Second-generation Asian men and first-generation Asian women had higher T2DM prevalence compared with their White peers. Such a trend was observed among Chinese and Filipino men, and Filipina and Korean women. In addition, Filipinas who spoke only English at home had lower odds of T2DM than other Filipinas (OR=0.3, 95% CI: 0.1-1.0) while the relationship was reversed among Filipino men (OR=3.2, 95% CI 1.0-10.1). Conclusions . Associations between generational status and T2DM among Asian Americans are non-linear and strongly influenced by gender and ethnicity.

China's 30-year economic boom has created a unique social and economic market for commercial sex, as well as for a workforce of migrant women from rural China. This qualitative study explores the impact of the rapidly changing social and economic environment on migration patterns, sexually transmitted infection (STI) knowledge, STI risk behaviours, and health beliefs among female streetwalkers in Shanghai. Qualitative data were collected in 2010 through semi-structured in-depth interviews with 16 streetwalkers to characterise their migration passages, sexual health and behaviours, and peer networks. Many streetwalkers reported histories of childhood impoverishment, of family or partner violence or trauma, of migration consistent with the timeline and routes of economic development, and of a scarcity in health, social, or economic support. Their knowledge of the prevention and treatment of HIV and STIs was limited. They had little bargaining power on condom use, and the majority resorted to vaginal douching and self-management with antibiotics as preventative measures. The study identifies streetwalkers’ perspectives on the changing environment, their options and actions, and finally HIV/STI risks that were unique to this hidden population.

Effective health care models to scale up combination antiretroviral therapy (ART) are needed in rural southwestern China. We aimed to evaluate the ART treatment outcomes and their associations with patients' demographic characteristics and pre-treatment clinical features in a scaled-up provincial ART program serving eight heavily HIV-affected prefectures in Yunnan Province. We abstracted information from a computerized database for adults initiating ART between July 2007 and September 2008. Survival functions of mortality and treatment failure were calculated by age group, gender, transmission mode, and baseline CD4 count. Multivariable Cox regression analyses were conducted to find independent associations of various demographic and baseline clinical features with outcome variables. Of the 1967 patients in the mortality analysis, there were 110 deaths, of which 16 were coded as accidents or suicides. Adjusted hazard ratios (AHR) associated with mortality were greater for patients with baseline CD4 counts <100 cells/µl vs. patients with CD4 counts ≥200 cells/µl, for male vs. female, for single vs. married, and for those acquired HIV through injection drug use (IDU) vs. other modes of transmission. Successful treatment was 81.3% at six months after treatment started. Immunologic treatment failure was associated with baseline CD4 counts but not with demographic characteristics. Overall loss to follow-up rate was 2.1%. Collaboration between clinics and community networks are distinctive features of Yunnan's model for scaling up ART across a diverse, poor, and rural population. This study finds that the strategy can succeed even if 40% of the patients have a history of IDU.

Background: Improving utilization of antenatal care is a critical strategy for achieving China’s Millennium Development Goal of decreasing the maternal mortality ratio (MMR). While overall utilization has increased recently in China, an urban vs. rural disparity in access remains. Here we aim to assess utilization of antenatal care in rural-to-urban migrant women and identify its risk and protective factors. Methods: Migrant women who had been living in Shanghai for more than six months, delivered in one of the two study hospitals between August 2009 and February 2010, and provided written consent were interviewed using a structured questionnaire. Results: Of 767 women, 90.1% (691) made at least one antenatal care visit, while 49.7% (381) had adequately utilized antenatal care (i.e., made five or more antenatal care visits). Only 19.7% of women visited an antenatal care center during the first trimester (12 weeks). Women between the ages of 25 and 30 and women older than 30 were more likely than younger women to have adequately utilized antenatal care (AOR=2.2 and 1.9, 95%CI=1.4-3.5 and 1.1-3.2, respectively). Women whose husbands held Shanghai residency status (AOR=4.9, 95%CI=2.2-10.9) or who had more than 10 years of education (AOR=1.8, 95%CI=1.2-2.9), previously experienced a miscarriage or abortion (AOR=2.2, 95%CI=1.3-3.8), had higher household income (AOR=1.6, 95%CI=1.0-2.5) were more likely to have adequately utilized antenatal care. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks (AOR=3.5, 95%CI=1.7-5.5). Conclusions: Many migrant women in Shanghai did not receive adequate antenatal care and initiated antenatal care later than the optimal first 12 weeks of pregnancy. Poor antenatal care utilization was associated with low socioeconomic status, education, and certain demographic factors. Tailored health education for both migrant women and their husbands should be strengthened to improve maternal health. Financing supports should be provided to improve the utilization of antenatal care.

Although the Chinese government provides free-of-charge voluntary HIV counseling and testing, HIV testing rates among men who have sex with men (MSM) are reported to be extremely low. This study examines the association of structural and psychosocial factors and social network characteristics with HIV testing behaviors among “money boys” and general MSM in Shanghai. Overall, 28.5% of “money boys” and 50.5% of general MSM had never tested for HIV despite high rates of reported HIV risk behaviors. Factors associated with not testing for HIV included: not knowing of a testing site, limited HIV knowledge, low perceived HIV risk, concern about HIV testing confidentiality, being a closeted gay, not using the Internet, and having a small social network or network with few members who had tested for HIV. Future efforts to promote HIV testing should focus on outreach to general MSM, confidentiality protection, decreasing the stigma of homosexuality, and encouraging peer education and support through the Internet and social networks.

As the HIV/AIDS epidemic and the spread of sexually transmitted infections (STIs) in China has come to the forefront of public health attention, female sex workers (FSWs) and their clients (CFSWs) are becoming increasingly important to HIV/STI prevention efforts. This secondary analysis uses data abstracted from the Chinese Health and Family Life Survey 1999–2000 to report prevalence rates of two STIs as well as sexual risk behaviors for CFSWs – men who paid for sex with FSWs in the past 12 months – in comparison with men who had not patronized FSWs. Among 1879 Chinese CFSWs who completed anonymous interviews and urine testing, 152 (6.3%, weighted) said they had paid for sex in the past 12 months and 18.8% of CFSWs (weighted) tested positive for gonorrhea. CFSWs were 10 times more likely to have an STI (either self-reported or tested) than non-client Chinese men, and they were equally likely to use condoms inconsistently with their spouses. This study highlights the importance of studying CFSWs who use condoms inconsistently and do not practice safe sex with their spouse as a potential bridge population. Prevention and intervention efforts should target this bridge population and include education on HIV/AIDS and STI transmission, condom promotion, marriage counseling, destigmatization of HIV and STIs, and promotion of STI diagnosis and treatment.

This study uses data from the nationally representative Early Childhood Longitudinal Study—Birth Cohort to examine the relationship between maternal depression, maternal sensitivity, and child attachment, specifically among Hispanic and Asian American mothers and their young children, and to explore the role of cultural variation and nativity in the associations between these variables. Data used in this study were collected from biological mothers on two occasions, when their children were approximately 9 and 24 months of age. Trained observers completed a direct assessment of child attachment security and an observational measure of maternal sensitivity, data on maternal depression was obtained via maternal report. Hierarchical logistic regression models were used to predict odds of child insecure attachment. The risk of child insecure attachment associated with chronic maternal depression was found to be much higher for Hispanic mothers than for Asians. In contrast, mothers’ foreign-born status was a stronger risk factor than depression for insecure child attachment among Asian Americans. Maternal sensitivity significantly reduced the odds of Asian American children being insecurely attached by more than half. Among the full sample of mothers, which included U.S.-born non-Hispanic White mothers and U.S.-born non-Hispanic Black mothers, decreased maternal sensitivity mediated the association between chronic depression and child insecure attachment. However, this mediation was not found in stratified analyses of Hispanic and Asian mothers. Finally, mothers’ nativity did not influence the extent to which maternal depression or sensitivity was associated with child attachment. These findings suggest that the associations between maternal depression, sensitivity, and child attachment are culturally specific, and that mothers’ immigrant status may be a risk factor in some racial/ethnic groups but protective in others.

While Asian Americans are less likely than most Americans to use health services, little is known about their barriers to pediatric care. This study seeks to describe the prevalence of delayed/forgone pediatric care and its association with parental acculturation status in recent-immigrant Chinese families. Survey data were obtained from 76 families across two community services sites. Half of the surveyed families reported delayed/forgone pediatric care in the previous 12 months. Low-income families in suburban areas reported greater financial burdens, linguistic barriers, and a higher prevalence of delayed/forgone care than low-income families living in downtown area. Middle class immigrant families reported cultural barriers as a reason for delayed/forgone care. Traditional beliefs and not medical insurance were significant predictors of delayed/forgone care. Culturally and linguistically appropriate studies on risk reduction interventions will be needed to address the linguistic and cultural barriers to health care access.