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Objective. The Chinese men who have sex with men (MSM) population is suffering from a high HIV infection rate owing to unprotected anal sex. The Health Belief Model (HBM) has been proven to be an effective frame associated with behavior maintenance. Based on HBM, we analyzed the beliefs associated with consistent condom use behavior with regular and nonregular partners among MSM to better provide targeted interventions and services. Methods. A study was conducted in Sichuan Province, China, from November 2018 to April 2019, and 801 eligible participants were recruited by snowball sampling. Sociodemographic characteristics, AIDS-related characteristics, sexual behaviors, condom use behavior, and dimensions of HBM were investigated. Univariate, single multivariate, and summary multivariate models were employed to analyze the factors associated with consistent condom use. Results. Of all participants, 39.1% and 53.6% had had anal sex with regular and nonregular partners in the last six months, respectively. Only 56.5% of them had used condoms consistently with regular partners, and only 60% of them had used condoms consistently with nonregular partners. When taking consistent condoms use with regular partners as the dependent variable, the dimensions of perceived threats ( ORM = 1.28 , 95% CI: 1.10, 1.49), perceived barriers ( ORM = 0.70 , 95% CI: 0.60, 0.82), self-efficacy ( ORM = 1.23 , 95% CI: 1.14, 1.32), and cues to action ( ORM = 1.21 , 95% CI: 1.02, 1.43) showed significant associations with the dependent variable. When taking consistent condoms use with nonregular partners as the dependent variable, the dimensions of perceived barriers ( ORM = 0.77 , 95% CI: 0.67, 0.89), self-efficacy ( ORM = 1.22 , 95% CI: 1.13, 1.32), and cues to action ( ORM = 1.53 , 95% CI: 1.30, 1.80) showed significant associations with the dependent variable. Conclusions. More attention should be focused on how to decrease the obstructive factors of condom use, how to improve the confidence of condom use, and how to layout more cues to action to promote consistent condom use behavior with regular and nonregular partners during anal sex among Chinese MSM.

Background CRF_BC recombinants, including CRF07_BC and CRF08_BC, were considered the predominant subtypes in China. Since the discovery of HIV-1 circulating recombinant form CRF 85_BC in Southwest China in 2016, this BC recombinant forms had been reported in different regions of China. However, the history and magnitude of CRF85_BC transmission were still to be investigated. Method We conducted the most recent molecular epidemiology of HIV-1 among newly reported HIV-1 infected patients in Sichuan in 2019 by sequencing and phylogenetic analysis of 1291 pol sequences. Then, we used maximum likelihood approach and the Bayesian Markov chain Monte Carlo (MCMC) sampling of pol sequences to reconstruct the phylogeographic and demographic dynamics of the CRF85_BC. Results HIV-1 CRF85_BC (68/1291, 5.27%) became the fourth most prevalent strain revealing a significant increase in local population. CRF85_BC were only found in heterosexually infected individuals and the majority of CRF85_BC (95.45%) were circulating among the people living with HIV aged 50 years and over (PLHIV50+), suggesting a unique prevalent pattern. The founder lineages of CRF85_BC were likely to have first emerged in Yunnan, a province of Southwest China bordering Sichuan, in the early 2000s. It then spread exponentially to various places (including Guangxi, Sichuan, et al) and became endemic around 2008.6 (2006.7–2010.2) in Sichuan. Conclusion Taken together, our findings on HIV-1 subtype CRF85_BC infections provided new insights into the spread of this virus and extended the understanding of the HIV epidemic in China.

By the end of 2017, a total of 110,872 people living with HIV (PLWH) had been diagnosed in Sichuan, including 42,496 AIDS patients, making Sichuan one of the provinces heavily affected by the HIV/AIDS epidemic. The male/female ratio was 2.8:1; the 20–49 age group accounted for 68.5% of infections; and the Han ethnic majority accounted for 68.1% and the Yi ethnic minority accounted for 30.3% of the total cases. PLWH have a wide range of occupations, with farmers, unemployed, and rural migrant workers taking up the majority. Transmission by injection drug use accounted for the majority of cases until 2010, with sexual transmission rapidly expanding in the last decade. By the end of 2017, nearly 79,000 PLWH were receiving antiretroviral treatment in Sichuan province. Mortality greatly declined in recent years among those who received treatment. The number of HIV-related deaths surpassed 5000 in 2017. A comprehensive surveillance network has been set up composed of routine screening, case reporting, sentinel surveillance, specific epidemiological investigation, estimation of the HIV epidemic, and analysis of the incidence rate in different risk groups. Education activities targeting different groups have been carried out from provincial level to prefecture level and communities. Free antiretroviral treatment during the past decade has reduced the mortality rate among PLWH and has improved the quality of their life. Tailored behavioral interventions were implemented to effectively change high-risk behaviors among key populations. Prevention of mother-to-child transmission (PMTCT) has covered all 21 prefectures and 181 counties. A comprehensive prevention and treatment system that takes the community as its basis, health departments its mainstay, and professional institutes its backbone, with the coordination of security, civil administration and education, and the general public have been established. Remarkable progress has been made, but a great challenge lies ahead to control HIV sexual transmission, particularly in minorities.

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Background The study examined concurrent illicit heroin use among methadone maintenance clients in China and its association with clients' demographic characteristics, treatment experience, and personal social network. Methods Face-to-face surveys were conducted with 178 clients randomly recruited from six methadone maintenance treatment (MMT) clinics in Sichuan, China. Concurrent heroin use was measured based on self-report of heroin use during the past 30 days and a confirmatory urine morphine test. The participants' demographic characteristics and treatment factors were measured and examined. The drug use status of their family members and friends was also assessed. Results A total of 80 participants (44.9%) who either reported illicit heroin use in the past 30 days or had a positive urine test were defined as using heroin concurrently. Having drug-using friends was significantly associated with increased concurrent heroin use. Longer length of treatment (2 years or longer) was associated with increased concurrent heroin use. Among those who had both drug-using family members and friends, more women (71.4%) than men (50.0%) used heroin. For those who had no drug-using family members or friends, more men (34.8%) than women (20.8%) used heroin. Discussion Study findings indicate an urgent need to address concurrent illicit heroin use among MMT clients. Further examination of the influence of social networks on concurrent drug abuse behavior is encouraged. Results also highlight the importance of understanding gender differences in treatment seeking and behavioral changes, which is crucial to the development of gender-specific treatment strategies.

The objective of this study is to explore an effective model of comprehensive intervention on HIV/AIDS among injecting drug users (IDUs) in communities located in urban areas and to evaluate its feasibility in Sichuan Province, China. A quasi-experimental study was designed so that various intervention measures were conducted in the intervention city but not in the control city. A Behaviour Surveillance Survey was introduced to evaluate intervention exposure and the effect of behaviour change. In the intervention city, services received by IDUs increased over time ( P < 0.001). Awareness of HIV increased from 34.2% in 2003 to 58.3% in 2004, and to 67.4% in 2005 ( P < 0.001). The proportion of IDUs surveyed who shared a needle the last time they injected drugs decreased from 17.1% in 2003 to 7.0% in 2005, and in terms of the past month from 42.4% in 2003 to 18.4% in 2005 ( P < 0.001). Data from a multivariate logistic regression analysis showed that comprehensive intervention was a protective factor for behaviour change (odds ratio [OR] =0.561; 95% confidence interval [CI], 0.424–0.741). A well-designed and organized comprehensive intervention programme will effectively change the high-risk behaviour among IDUs in these communities. A more comprehensive, expanded and integrated response is needed when conducting an HIV/AIDS prevention programme.

Objective. To investigate factors associated with HIV infection and the frequency and willingness of male circumcision among men who have sex with men (MSM) in Chengdu city, China.Methods. A cross-sectional survey provided information on participants' demographics, risk behaviors, circumcision, and uptake of HIV prevention services.Results. Of 570 participants, 13.3% were infected with HIV and 15.9% with syphilis. An estimated 43.0% of respondents reported having unprotected receptive anal intercourse, and 58.9% reported having ≥2 male sexual partners in the past 6 months. Multivariable logistic regression revealed that syphilis, more male sex partners, predominantly receptive anal intercourse, and exclusively receptive male sex were associated with HIV infection. Higher level of education and peer education service were inversely associated with HIV infection. Nearly a fifth (18.0%) of participants were circumcised. More than half of uncircumcised participants expressed willingness to be circumcised.Conclusion. This study reveals a high prevalence of HIV and syphilis among MSM in Chengdu province of China. The frequency of unprotected receptive anal intercourse and multiple male sexual partnerships highlight the urgency for an effective comprehensive HIV prevention strategy. Although the willingness to accept male circumcision (MC) is high, further research is needed to assess the protective effective of MC among MSM.

Objective This study applied a stage-of-change model to examine the motivational profiles of clients seeking methadone maintenance therapy (MMT) in China. Methods Face-to-face interviews were conducted with a total of 179 clients from six MMT clinics. The University of Rhode Island Change Assessment (URICA) scale was used to measure the participants’ motivation and readiness to change. Cluster analysis was performed to classify the sample into subgroups with respect to their change dimensions. Results The study sample was allocated into five distinct clusters: uninvolved, denial, pre-participation, ambivalent, and participation. Participants who were classified in the denial cluster were older than those in the pre-participation and participation clusters. A higher level of motivation to change was positively associated with continued heroin use and more severe drug problems. Discussion It would be beneficial to evaluate motivational profiles of individual clients in the treatment planning process and provide tailored interventions for sustained treatment retention and outcomes.

Three community-based surveys recruited 4,310 injection drug users (IDUs) in China from 2004 to 2006. Of the participants, 54.4% were ≤ 3-year new IDUs; 63.9% reported injecting more than two times daily; 31.5% shared needles in the last six months; 37.4% shared equipments in the last month; 30.2% reported their regular sex partners injected drugs; and 23.5% had commercial sex, with 52.2% reporting no condom use during last sex. The risky injection practices (sharing needles/equipments and high injection frequency) were less frequent among new IDUs, emphasizing that effective prevention needs to identify and intervene with IDUs early on. The study's limitations are noted.