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Three consecutive cross-sectional surveys were conducted among injection drug users (IDUs). Of 2,530 participants, 47.7% reported ever sharing needles, 78.2% having had unprotected sex in the last month, 34.4% not receiving either methadone maintenance therapy (MMT) or HIV voluntary counseling and testing (VCT), 4.8% ever receiving MMT-only, 36.6% ever receiving VCT-only, and 24.2% ever receiving both MMT and VCT. MMT-only and the combination of MMT and VCT had significant associations with needle sharing and on unprotected sexual behaviors. Effectively integrating VCT into MMT services is a logical way to maximize the impact of both interventions on risky behaviors among IDUs. [ABSTRACT FROM AUTHOR]

To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s. The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV’s social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role. Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) are recognized as being at high risk for HIV infection. While studies have found that the prevalence of risky behaviors routinely remained high among MSM, few have focused on reasons why MSM may perceive they were or were not at risk for HIV infection. The objective of this study was to examine HIV risk perception among MSM in Beijing and Chongqing, China. A qualitative study consisting of eight focus group discussions and 65 in-depth interviews were conducted with MSM in the two cities. Participants felt that most MSM were aware of the high prevalence of HIV infection among MSM. Yet despite this awareness, most participants thought it was unlikely they would become infected with HIV. The reasons raised by participants included: AIDS was a foreign disease, cleaning after sex prevented transmission, being the insertive partner during sex was not risky, their partner(s) could be trusted, and feeling lucky made HIV/AIDS acquisition unlikely. The findings of this study suggest that a multi-pronged and tailored approach is needed to increase risk perception and safe sex behaviors among MSM in China. This may be achieved through HIV/AIDS interventions that use MSM-friendly media targeting misconceptions of HIV risk, stigma, and discrimination rather than simply distributing condoms. [ABSTRACT FROM AUTHOR]

Background: Since 1989 when the first 146 HIV positives in China were identified, Dehong Prefecture had been one of the areas hardest-hit by HIV in China. The local and national governments have put substantial financial resources into tackling the HIV epidemic in Dehong from 2004. The objective of this study was to track dynamic changes in HIV-1 prevalence and incidence among five focal populations in Dehong and to assess the impact of HIV prevention and control efforts.Methods: Consecutive cross-sectional surveys conducted in five focal populations between 2004 and 2008. Specimens seropositive for HIV were tested with the BED IgG capture enzyme immunoassay to identify recent seroconversions (median, 155 days) using normalized optical density of 0.8 and adjustments.Results: From 2004 to 2008, estimated annual HIV incidence among injecting drug users (IDUs) decreased significantly [from 15.0% (95% CI = 11.4%-18.5%) in 2004 to 4.3% (95% CI = 2.4%-6.2%) in 2008; trend test P < 0.0001]. The incidence among other focal populations, such as HIV discordant couples (varying from 5.5% to 4.7%), female sex workers (varying from 1.4% to 1.3%), pregnant women (0.1%), and pre-marital couples (0.2 to 0.1%) remained stable. Overall, the proportion of recent HIV-1 infections was higher among females than males (P < 0.0001).Conclusions: The HIV epidemic in Dehong continued to expand during a five-year period but at a slowing rate among IDUs, and HIV incidence remains high among IDUs and discordant couples. Intensive prevention measures should target sub-groups at highest risk to further slow the epidemic and control the migration of HIV to other areas of China, and multivariate analysis is needed to explore which measures are more effective for different populations. [ABSTRACT FROM AUTHOR]

Background: The HIV epidemic continues to expand among men who have sex with men (MSM) in China. The NIMH Project Accept/HPTN 043 trial suggested a borderline significant trend toward HIV incidence reduction among persons with higher testing rates., Methods: We assessed HIV testing histories and infection status among a community-based Beijing MSM. HIV serostatus was lab confirmed. We ascertained demographic/behavioral factors through questionnaire-based interviews. Associations of previous HIV testing with odds of current HIV infection were assessed, seeking improved like-with-like risk comparisons through multivariable logistic regression analysis with propensity score adjustment and restricted cubic spline modeling., Results: Among 3588 participants, 12.7% were HIV infected; 70.8% reported having ever tested for HIV. Compared with MSM who never tested, those ever testing had a 41% reduction in the odds of being HIV positive [adjusted odds ratio (aOR): 0.59; 95% confidence interval (CI): 0.48 to 0.74. Higher HIV testing frequencies were associated with a decreasing trend in the odds of being infected with HIV vs. a referent group with no previous testing [>6 tests (aOR: 0.27; 95% CI: 0.18 to 0.41); 4-6 (aOR: 0.55; 95% CI: 0.39 to 0.78); 2-3 (aOR: 0.61; 95% CI: 0.45 to 0.82); P for trend <0.001]. The multivariable-adjusted model with restricted cubic spline of HIV testing frequency showed a higher frequency of previous HIV testing associated with lower odds of HIV infection, particularly among men with ≥10 lifetime male sexual partners., Conclusions: Using risk probability adjustments to enable less biased comparisons, frequent HIV testing was associated with a lower HIV odds among Chinese MSM.

This study assessed gender and ethnic disparities of HIV and syphilis seroconversions in a cohort of injection drug users (IDUs) in Southwest China. A cohort of HIV-seronegative IDUs was followed up from November 2002 to January 2007. The average seroincidence for HIV and syphilis was 2.2 and 4.2 per 100 person-years (PYs), respectively. Multivariable Poisson regression models indicated that the predictors for incident HIV seroconversion included non-Han minority ethnic groups (RR: 5.2; 95% CI: 1.9-14.4) and injecting drugs > or = 7 times/week in the past 3 months (RR: 3.6; 95% CI: 1.4-9.8). The predictors for incident syphilis seroconversion included female (RR: 4.1; 95% CI: 1.8-9.3) and being married or cohabiting (RR: 2.7; 95% CI: 1.2-5.9). These findings suggested that HIV continues to spread among IDUs, especially among Yi and other minority ethnic groups, and frequent risky injections might be the major diver of the epidemic. Female IDUs are disproportionally affected by syphilis. Further research is needed to better understand the ethnicity disparity for HIV and gender disparity for syphilis.

Objectives: To assess HIV and syphilis infection among men who have sex with men (MSM) in Chinese regions with historically low HIV prevalence., Method: A cross-sectional survey was conducted in 20 cities or districts across 4 provinces, 2 autonomous regions, and a municipality. Socioeconomic/behavioral risk factors were measured. Blood samples were tested for HIV via enzyme-linked immunosorbent assay and Western blot confirmation and syphilis via rapid plasma reagin and passive particle agglutination test for detection of Treponema pallidum Antibodies., Results: Of 4983 MSM participants, 2.9% were HIV infected (range: 0%-15.1%) and 9.8% were syphilis infected (1.3%-29.3%). Syphilis infection was associated with older age [adjusted odds ratio (AOR) = 2.9; 95% confidence interval (CI): 2.0 to 4.3], not being married or cohabiting (AOR = 0.7; 95% CI: 0.5-0.9), less education (AOR = 1.3; 95% CI: 1.0 to 1.7), inconsistent condom use during anal sex with men (AOR = 1.4; 95% CI: 1.0 to 1.8), and living in inner Mongolia (AOR = 23.9; 95% CI: 9.7 to 58.6), Jilin (AOR = 7.9; 95% CI: 3.4 to 18.3), Heilongjiang (AOR = 7.1; 95% CI: 3.1 to 16.6), Liaoning (AOR = 6.1; 95% CI: 2.6 to 14.2), or Chongqing (AOR = 5.9; 95% CI: 2.5 to 13.9). HIV infection was associated with older age (AOR = 3.7; 95% CI: 2.0 to 6.7), less education (AOR = 2.9; 95% CI: 1.8 to 4.7), inconsistent condom use during anal sex with men (AOR = 1.9; 95% CI: 1.2 to 3.2), syphilis infection (AOR = 2.1; 95% CI: 1.3 to 3.4), and living either in Liaoning (AOR = 8.2; 95% CI: 1.1 to 61.4) or Chongqing (AOR = 57.2; 95% CI: 7.9 to 414.4)., Conclusions: HIV and syphilis have reached alarming rates in China's MSM population, thus, appropriate responses are urgently needed.

Objective: To investigate the incidence of HIV-1, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections and predictors associated with retention in a 12-month follow-up study among men who have sex with men (MSM) in Beijing, China., Methods: A total of 507 eligible seronegative MSM were enrolled. Study participants were tested for HIV-1, syphilis, HBV, and HCV and counseled at the baseline, 6-month, and 12-month follow-up visits. The retention rates were analyzed as a function of demographic, behavioral, and recruitment variables., Results: Of the 507 participants, 86.2% (437) were retained in the cohort at the 12-month follow-up visit. The incidence rates were 2.6 per 100 person-years [95% confidence interval (CI): 1.1% to 4.1%] for HIV-1 infection, 16.9 per 100 person-years for syphilis (95% CI: 12.4% to 21.3%), 3.3 per 100 person-years for HBV (95% CI: 1.5% to 5.1%), and 0.2 per 100 person-years for HCV (95% CI: 0% to 0.7%). Higher education (adjusted odds ratio = 1.94, 95% CI: 1.03 to 3.66) and appearing at the 6-month follow-up visit (adjusted odds ratio = 26.15, 95% CI: 13.44 to 50.89) were significantly associated with 12-month retention., Conclusions: HIV, syphilis, and HBV incidence are high among MSM. Intensified intervention is needed urgently. Widespread screening for HIV, syphilis, HBV, and HCV in this group should be considered as measures for control.

The purpose of this study was to assess the prevalence and risk factors for syphilis infection among female sex workers (FSWs) in Liuzhou City, Guangxi Zhuang Autonomous Region, southern China. A cross-sectional study recruited FSWs using a venue-based method and subsequent snowball sampling with mapping strategies. Questionnaire-based interviews were conducted to collect demographic and behavioral information. Blood was tested for syphilis (RPR with TPPA confirmation) and HIV (EIA with Western blot confirmation) infections. Of the 362 eligible participants, 81.7% were non-local residents (60.5% from other parts of Guangxi and 21.2% were non-Guangxi residents); 58.0% belonged to non-Han minority ethnic groups; 37.5% reported inconsistent condom use with their clients and 71.2% reported inconsistent condom use with their regular sex partners during the past month. Nearly 10% reported having had sex with drug users. The prevalence rates for HIV and syphilis infections were 2.3% and 11.0%, respectively. Almost half (46.6%) of participants reported having had STD symptoms. Inconsistent condom use with clients in the past month (AOR = 5.0; 95% CI = 1.8-13.8), less education (OR = 2.6; 95% CI = 1.1-7.4), and HIV infection (AOR = 8.1; 95% CI = 1.1-68.5) were independently associated with syphilis infection.

Objective: To examine the prevalence and predictors of HIV and syphilis infections among men who have sex with men (MSM) in Chongqing municipality, China., Methods: Cross-sectional studies were conducted in three districts of Chongqing municipality from July to September, 2006 and 2007, respectively. Questionnaire-based interviews were conducted to provide information on demographic characteristics, behaviors on sex and drug use, and HIV and sexually transmitted diseases (STD) related health services. Blood samples were tested for HIV and syphilis infections., Results: Of 1773 participants, 10.6% were HIV-positive and 8.4% were sero-positive for syphilis infection. Factors independently associated with HIV infection included older age (26-35 year: AOR = 1.7, 95% CI: 1.1-2.6; >35 years of age: AOR = 2.3, 95% CI: 1.4-3.8), low level of education (AOR = 2.3, 95% CI: 1.5-3.5), having had multiple male sex partners (AOR = 1.8, 95% CI: 1.2-2.8), venues of recruitment from bathhouses/sauna (AOR = 2.3, 95% CI: 1.1-4.7), with self-reported STD symptoms in the past 12 months (AOR = 1.8, 95% CI: 1.2-2.7) and syphilis infection (AOR = 1.7, 95% CI: 1.1-2.9)., Conclusion: The prevalence rates on both HIV and syphilis infections were considered to be high among MSM in Chongqing city. Unprotected anal sex and multiple sex partners were common in this group. Education, condom promotion, combination of HIV and STD screening, and treatment to the diseases are essential to this population in Chongqing. However, MSM had not hitherto been perceived to be in the epidemic mainstream in this area.

To estimate the prevalence of HIV and syphilis and to assess the predictors of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in Beijing, a community-based survey recruited MSM in 2005 through internet advertisement, community outreach, and peer referral. Demographic, sexual, and HIV risk behavioral information were collected. Serospecimens were tested for HIV and syphilis infections. Of the 526 participants, 3.2% were HIV-positive, 11.2% syphilis-positive, 50% and 43.3% had UAI with regular and casual sex partners, respectively. Participants practicing UAI with regular male partners were independently associated with lower monthly income (adjusted odds ratio-AOR, 1.7; 95% CI, 1.0-3.0) and encountering male sex partners at bathhouses, public washrooms, and parks (AOR, 2.2; 95% CI, 1.0-4.9). Participants practicing UAI with casual male partners were associated with encountering male sex partners at bathhouses, publics washrooms, and park (AOR, 3.0; 95% CI, 1.8-5.2) and more male sex partners having receptive anal intercourse (AOR, 1.8; 95% CI, 1.1-2.9), and was inversely associated with receiving money for sex with men (AOR, 0.3; 95% CI, 0.2-0.7). Professional male sex workers were less likely to practice UAI in Beijing, suggesting the benefits of educational outreach to date. Further education, condom promotion, and prevention of sexually transmitted infections should be intensified urgently to combat the rising HIV epidemic among MSM in Beijing.

The objective of this paper is to describe the evolution of human immunodeficiency virus/acquired immunodeficiency syndrome surveillance in mainland China, with a focus on reviewing the sources of data being used for improved surveillance of HIV/AIDS. We review the development of HIV/AIDS surveillance and its multiple data sources to monitor the dynamics of HIV/AIDS in China. The surveillance system for HIV/AIDS in China was initiated in 1986. It has evolved in three stages: (1) passive surveillance, (2) HIV sentinel surveillance with coexisting active surveillance and passive surveillance, and (3) comprehensive surveillance. In parallel with the evolution of the surveillance system itself, the HIV epidemic in China has gone through increasing stages of complexity, through an Introduction Phase, a Spreading Phase, and a Rapidy Spreading Phase. More reliable data from improved surveillance suggest that the HIV/AIDS epidemic is expanding in China. HIV infections among 2005 estimates remain concentrated among injection drug users (IDUs), those buying and selling sex, and men who have sex with men. Better HIV/AIDS surveillance synthesizes multiple data sources to provide a more accurate picture of the dynamics of specific HIV/AIDS circumstances in different areas of China. Improved surveillance is meaningful insofar as data are used to implement more effective HIV prevention programs in China. Support for surveillance and strategic analyses can enable policy decision makers to make more effective program choices and mobilize adequate resources to contain HIV.