Huachun Zou

Recent upsurge of new HIV infections among men who have sex with men (MSM) is a major concern in China. Paucity of national-level information regarding the burden and predictors of this progressive epidemic of new infections called for a multi-centric, timely and comprehensive investigation. Mixed methods were used to recruit MSM from seven cities in China between 2012 and 2013. Recent and established HIV infections were estimated by Western Blot and BED HIV-1 capture enzyme immunoassay. Syphilis and herpes simplex virus-2 (HSV-2) were also tested. A total of 4496 eligible MSM were recruited. The majority was aged ≤35 years (77.5 %), migrants (60.3 %), never married (69.8 %), and played receptive role in anal sex (70.5 %). The HIV prevalence was 9.9 %, and 41.9 % were recently infected, with sensitivity/specificity adjusted HIV incidence of 8.9 (95 % CI: 7.6-10.2)/100 Person-Years. The prevalence of history HSV-2 and syphilis were 12.5 % and 8.5 %, respectively. Recent HIV infection was associated with having multiple male partners (aOR = 1.4, 95 % CI 1.1-1.9), recreational drug use (aOR = 2.2, 95 % CI 1.6-3.0), anal bleeding (aOR = 2.1, 95 % CI 1.4-3.0), syphilis infection (aOR = 2.8, 95 % CI 1.9-4.3) and history HSV-2 infection (aOR = 2.3, 95 % CI 1.5-3.3). High rate of recent HIV infection is potentially resulting in progressive deterioration of the overall HIV epidemic among MSM in China. Targeted interventions to address high-risk MSM including those having multiple partners, history of recreational drug use and syphilis or HSV-2 infection seemed to be the need of the hour.

Sexually transmitted infections (STIs) increase HIV infectivity through local inflammatory processes. Prevalent and incident STIs among people who live with HIV/AIDS (PLWHA) are indicators of high-risk sexual behaviors and imply potential spread of HIV. Little is known about the prevalence and incidence of concurrent syphilis and associated risk behaviors among PLWHA in China. A retrospective cohort study was conducted among PLWHA who attended the outpatient clinic of a designated AIDS treatment hospital in Shenyang, China, between March 2009 and May 2013. Physical examinations and syphilis serology were conducted at each visit. A questionnaire on demographic characteristics was also collected. A total of 1010 PLWHA were enrolled, of whom 77.0% were men who have sex with men (MSM). The baseline syphilis prevalence among PLWHA was 19.8% (95% confidence interval [CI]:17.3–22.3%). During follow-up, 78.3% retained in the cohort, and contributed a median follow-up of 9.4 months (interquartile range: 5.9-18.7 months). Syphilis incidence among PLWHA was 18.7 (95% CI: 15.5–21.8) per 100 person years. Mulitvariate logistic analysis showed that receiving antiretroviral therapy (ART) (adjusted OR [aOR] = 0.48), older age (≥40 years vs. ≤24 years, aOR = 2.43), being MSM (aOR = 2.30) and having higher baseline HIV viral load (>100000 copies/mL vs. ≤100000 copies/mL, aOR = 1.56) were independent predictors for syphilis infection among PLWHA at enrollment (p < 0.05 for all). Mulivariate Cox regression found that receiving ART (adjusted hazard ratio [aHR] = 1.81), older age (≥40 years vs. ≤24 years, aHR: 5.17) and MSM status (aHR = 2.68) were independent risk factors for syphilis seroconversion (each p < 0.05). Syphilis prevalence and incidence were high among PLWHA in Shenyang. A campaign focusing on detection and treatment of syphilis among PLWHA is urgently needed, especially one with a focus on MSM who are at a higher risk for syphilis.

We systematically reviewed and meta-analyzed global data on the relative risk for HIV infection among men who have sex with men (MSM) engaging in different roles in anal sex. MSM engaging in receptive anal sex only (MRAI) and MSM engaging in both insertive and receptive anal sex (MIRAI) were 6.9 (95 % CI 5.5–8.6) and 4.3 (95 % CI 3.6–5.3) times more likely to have prevalent HIV compared to MSM engaging in insertive anal sex only (MIAI) in 1981–1985. These figures were 1.8 (95 % CI 1.6–2.0) and 2.2 (95 % CI 2.0–2.4) in 1986–2010. Overall, MRAI and MIRAI were 6.2 (95 % CI 3.3–11.8) and 6.6 (95 % CI 3.8–11.7) times more likely to develop incident HIV infection compared to MIAI. MRAI are at higher risk for HIV infection compared to MIAI. HIV prevalence among men engaging in all roles in anal sex is high enough that all MSM should be aware of potential risk.

Background: The year-by-year trend of HIV prevalence among men who have sex with men (MSM) in China is not well documented. Methods: Published studies on HIV prevalence among MSM in China were reviewed and grouped by year, region and age group. Meta-analysis was used to summarise the estimates of national and regional HIV prevalence rates and trends among MSM from 2003 to 2009. HIV prevalence among MSM in different age groups (<25 years old v. ≥25 years old) was also calculated. Results: Eighty-three publications were included in the meta-analysis. The pooled HIV prevalence among MSM in China increased from 0.6% (95% confidence interval (CI): 0.0–2.1%) in 2003 to 7.4% (95% CI: 5.7–9.2%) in 2009. A yearly increase of 1.1% (95% CI: 0.5–1.5%, P < 0.001) in HIV prevalence was detected. The pooled regional HIV prevalence among MSM ranged from 2.3% (95% CI: 1.7–2.9%) in east China to 11.4% (95% CI: 9.2–13.6%) in south-west China. No difference was detected (χ2 = 0.5160, P = 0.4726) between HIV prevalence in the <25-year-old age group (3.1%, 95% CI: 1.6–4.6%) and that in the ≥25-year-old age group (4.0%, 95% CI: 1.8–6.3%). Conclusion: The HIV prevalence among MSM in China is high and climbing. Effective strategies are required to prevent the epidemic from continuing to spread.

Men who have sex with men (MSM) especially those who are HIV positive are at risk for HPV-associated anal cancer. We systematically reviewed studies with data on the prevalence of vaccine preventable anal HPV among men who have sex with men aged 25 or younger and identified 6 studies. None of these studies were specifically designed to determine the prevalence of HPV in this population. Available data, albeit limited, suggest many young MSM may not already be HPV infected. Further studies using representative sampling focused on teenage MSM are required to confirm this.

HIV testing among men who have sex with men (MSM) in China has not been well studied. We systematically reviewed studies addressing HIV testing among MSM in China and conducted a meta-analysis on testing indicators before and after the adoption of China’s National Plan for HIV/AIDS Prevention and Control among MSM in 2007. Rate of lifetime HIV testing (24 % [period 1—before adoption] vs. 47 % [period 2—after adoption]) and testing in the past 12 months (21 vs. 38 %) were both significantly higher in period 2. Rate of lifetime pre-test counseling showed a significant increase from period 1 to period 2 (72 vs. 90 %), while the figure for the past 12 months pre-test counseling did not change (51 vs. 50 %). More efforts are needed to promote frequent HIV testing among MSM. Pruebas de VIH en HSH en China no han sido bien estudiadas. Sistemáticamente hemos revisado estudios dirigidos a pruebas de VIH en HSH en China y hemos conducido un meta-análisis sobre los indicadores antes y después de la adopción del Plan Nacional chino para la Prevención y Control de VIH/SIDA en HSH en 2007. La tasa de pruebas de vida de VIH (24 % [periodo 1 – antes de la adopción] vs. 47 % [periodo 2 – luego de la adopción]) y pruebas en los pasados 12 meses (21 vs. 38 %) son significativamente más altos en el periodo 2. La tasa de consejería de vida antes de la prueba mostró un significativo incremento del periodo 1 al periodo 2 (72 vs. 90 %), mientras que la figura por los pasados 12 meses de consejería previo a la prueba no cambió (51 vs. 50 %). Más esfuerzos son necesarios para promover las pruebas frecuentes de VIH en HSH.

In this review, we describe condom use and its influencing factors in China, with a particular focus on the five populations that are at high risk for HIV/sexually transmissible infections (STI) infection: female sex workers, men who have sex with men, migrant workers, young people and sero-discordant couples. The risk for HIV/STI infection is high while condom use rates are low among these five populations. The 100% Condom Use Programme was successful in trial regions in increasing condom use and decreasing HIV/STI prevalence; however, long-term and routine condom promotion strategies should be in place to ensure better awareness of condom use, high availability of condoms and high rate of condom use among populations at high risk of HIV/STI infection in China. Realistic and vigorous condom-related policies and action plans should be developed and implemented to address the issues and barriers facing condom promotion in China.