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Background Drug users are regarded as a high-risk population of HIV infection. Non-occupational post-exposure prophylaxis (nPEP) is internationally regarded as an effective biomedical prevention against HIV but still a small-scale pilot project in China at present. The aim of this study was to understand drug users’ perceptions, demands and suggestions for nPEP service in China. Methods Nineteen eligible drug users were recruited in this qualitative study. Semi-structured in-depth interviews were conducted by trained interviewers. All of the interviews were audio-taped, transcribed verbatim and analyzed using thematic framework analysis. Results Most of participants had not heard of nPEP and none of them had used this service. After being informed basic knowledge of nPEP, about half of the participants reported willingness to use it. The facilitators included scare of HIV infection and regarding nPEP as a remedial measure in emergency. The barriers included low willingness for fatigue and lethargy after taking drugs, high price and side effects of nPEP medication, long course of nPEP treatment, and fear of privacy disclosure. Most of the participants thought the availability of nPEP would not increase the occurrence of unprotected intercourse and supported the routinization of nPEP services. Most participants chose social media for nPEP propaganda and pharmacies for providing nPEP. Conclusions It is imperative to strengthen propaganda and education of nPEP among drug users, and to encourage them to proactively use nPEP after exposure. Price regulation, side effect management and privacy protection need to be managed well when nPEP is routinized.

Few studies have examined the association between methamphetamine (MA) abuse and sexually transmitted infection (STI) risk among heterosexual male MA users in China. A total of 288 heterosexual male MA users who met our inclusion criteria were recruited from nightclubs, KTVs, bars, bath centres and an STI clinic. STIs were screened among the participants, and the risk factors related to STIs were analysed by multivariate logistic regression in SPSS 11.0. Among the 288 heterosexual male MA users, 51 (17.7%) had syphilis, 36 (12.5%) had genital warts, 2 (0.7%) had genital herpes, 3 (1.0%) had HIV infection and 41 (14.2%) had urethritis. STIs were associated with the following variates: ‘MA has the function of anti-inebriation’ (OR = 2.522, 95%CI = 1.337–4.756), ‘I am addicted to MA’ (OR = 4.030, 95%CI = 2.194–7.401), ‘It occurred to me to abstain from MA’ (OR = 2.939, 95%CI = 1.246–6.934), ‘Years of MA abuse’ (OR = 2.622, 95%CI = 1.318–5.215), ‘Times of MA abuse per week’ (OR = 5.275, 95%CI = 1.988–14.002), ‘Number of persons using MA together’ (OR = 2.579, 95%CI = 1.246–5.340) and ‘Number of female sex workers as sex partners per MA abuse’ (OR = 4.004, 95%CI = 1.526–10.508). Our findings show that MA users belong to the high-risk group for STI in China. STIs, except for HIV, have spread widely among heterosexual male MA users. Thus, specific interventions must be conducted to prevent the spread of STIs in this population in China.

Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic.

Background In China, the mode of HIV transmission and the types and routes of drug use have changed in the past decade. HIV testing amongst drug users needs further improvement. Methods Interviewer-administered questionnaires were used for data collection amongst 600 heterosexual drug users from the community and a municipal detention centre, where criminal suspects are supervised. Descriptive statistics, univariate analysis and multilevel logistic regression analysis were used to identify the factors associated with HIV testing amongst heterosexual drug users. All participants were screened HIV and sexually transmitted infections. Results Amongst 600 participants, 554 (92.3%) were methamphetamine users, and 155 (25.8%) underwent HIV testing in the past year. Multivariate analysis results revealed that drug users who were single (adjusted odds ratio(AOR) = 1.923, 95% confidence interval(CI) = 1.189-3.109), had less knowledge of HIV (AOR = 1.706, 95% CI = 1.074-2.711), used only one kind of drug (AOR = 2.649, 95% CI = 1.155-6.077), used drug via a non-injection route (AOR = 2.121, 95% CI = 1.103-4.078), did not receive free condoms (AOR = 2.307, 95% CI = 1.129-4.715) and who did not receive free publicity material from health workers in the past year (AOR = 2.828, 95% CI = 1.757-4.552) were less likely to undergo HIV testing. A total of 594 participants underwent HIV and syphilis screening in this survey. Amongst these participants, 2 (0.3%) were HIV antibody positive, and 88 (14.8%) showed positive results in both non-treponemal test (rapid plasma regain test) and treponemal test (Treponema pallidum particle agglutination test) for the first time. Conclusions The rate of HIV test uptake amongst heterosexual drug users in China remains low. Thus, more specific interventions are urgently needed to improve the utilisation of HIV testing amongst heterosexual drug users, particularly amongst non-injection drug users in China.

To analyze the epidemiological characteristics of annual reported people living with HIV/AIDS (HIV/AIDS)in Qingdao city, Shandong province from 2010 to 2014 and to provide theoretical evidence for strategies on targeted prevention and control.Information on annual reported HIV/AIDS and sentinel surveillance data from 2010 to 2014 was abstracted from the HIV/AIDS Comprehensive Response Information Management System (CRIMS). Statistical analysis was done by SPSS software.The number of annual reported HIV/AIDS increased from 2010 to 2014 in Qingdao, with the sex ratio as 10.8. Among all the patients, 77.1% were aged 20-39 years, 65.6% were unmarried, 67.6% graduated from high school or above. Homosexual contact was the major mode of transmission, and the prevalence of MSM increased yearly (P0.05).MSM appeared the major high risk population for AIDS epidemic in Qingdao. However, surveillance projects should also be strengthened among the female population with multiple sexual partners. Optimal prevention and control measures based on the characteristics of AIDS epidemic should be developed to explore the stern spread and epidemics of the disease, in Qingdao.

The objective of this study was to assess the factors associated with methamphetamine (MA) use, syphilis, and unprotected sex among female sex workers from different type of venues in Qingdao City, Shandong Province of China. Three consecutive cross-sectional surveys provided information on demographics, sexual and drug use behaviors, and HIV-related services. Of 1187 participants, 3.0% were infected with syphilis; 30.2% ever used MA; 58.3% ever had unprotected commercial sex in the past month. The prevalence rates of syphilis and MA use were 2.5% and 33.0% for participants recruited from saunas, night clubs, bars or hotels; 2.7% and 28.3% for hair/beauty salon-based participants; and 4.5% and 15.8% for street-based participants. Street-based MA users were more likely to be single, non-Shandong residents, have first lifetime sex act at younger age, and recruited in 2008 (vs. 2006). Saunas, night clubs, bars, or hotels-based MA users were more likely to be younger, sex debut at younger age, have longer duration of sex work, have unprotected commercial sex, and be syphilis-infected. Hair/beauty salon-based MA users were more likely to be non-Shandong residents, younger, and to have unprotected commercial sex. Syphilis among the sauna-, night club-, bar-, or hotel-based participants was associated with MA use and ever receipt of HIV testing. Syphilis among the hair/beauty salon-based participants was associated with longer duration of sex work. MA users who frequent commercial sex venues are engaging in high-risk behaviors and are at risk for syphilis/other sexually transmitted diseases. Better-targeted intervention efforts to curtail the epidemics of MA use and HIV/syphilis should therefore take cognizance of the role of commercial sex venues as focal points of MA use and syphilis/sexually transmitted disease transmission.

To understand the characteristics of recreational drug users' behaviors and social network, as well as their potential impact to the transmission of sexual transmitted infections (STI).Qualitative interview was used to collect information on rough estimation of population size and behavior change before and after recreational drug use. A total of 120 participants were recruited by convenient sampling from April to October, 2013 in a community of Qingdao city. Blood specimens were taken for HIV/syphilis serological testing and social network analysis was performed to understand the characteristics of their behavior and social network.All participants used methamphetamine and 103 of them showed social connection. The prevalence of syphilis and HIV were 24.2% (29/120) and 2.5% (3/120) respectively. The estimated size of recreational drug users was big with a wide diversity of occupations and age range, and males were more frequent than females. Drug use may affect condom use and frequent drug users showed symptom of psychosis and neuro-toxicities. The size of social network was 2.45 ± 1.63 in the past 6 months, which indicated an increasing trend of the sexual partner number and risky behaviors.Recreational drug use could increase the size of social network among sex partners, the frequency of risky sexual behaviors and syphilis prevalence, which indicate a high risk of HIV/STI among this population as well as a huge burden of disease prevention and control in the future.

To explore the prevalence of syphilis and HSV-2 among female sex workers (FSWs) who use new types of drugs in Jiaozhou city.Through convenient sampling, an anonymous questionnaire survey was conducted among female sex workers to collect demographic characteristics, new-type drugs abusing characteristics and related sexual behaviors from October to December, 2013. Blood specimens were drawn for serological tests of syphilis antibody and HSV-2 antibody. Urine specimens of the subjects surveyed were collected to test for methamphetamine. Differences in demographic characteristics, new-type drug abusing characteristics, and sexual behaviours between drug-abusing FSWs and non-drug-abusing FSWs were compared by t-test and χ(2)-test.A total of 460 FSWs were recruited in this study, and 105 FSWs admitted their drug abuse history. Among the 341 urine specimens confirmed to be methamphetamine positive, there were 3 FSWs claimed that they never abuse new-type drugs. The rate of new-type drug abuse was 23.5% (108/460). A total of 71.4% (75/105) of the new drug-abusing FSWs started using drugs under 25 years old. The main reasons for drug abuse were clients request (24, 22.9%), making more money (23, 21.9%) and companion temptations (22, 21.0%). Totally, 41.9% of them (44/105) took drugs with 4-5 persons, 32.4% (34/105) had sex with 2-3 men after taking drugs, and 60.2% of new-type drug-abusing FSWs (65/108) used condoms in the latest commercial intercourse, while only 7.4% FSWs (8/108) used condoms every time during their commercial sex activities in the recent month. Compared with FSWs having no drug abuse behavior, drug-abusing FSWs had higher single proportion (73.2% (79/108) vs 63.6% (224/352), χ(2) = 8.64, P0.05), lower condom use rate in the recent month (7.4% (8/108) vs 22.7% (80/352), χ(2) = 12.53, P0.01) and higher pregnancy rate in the recent 6 months (24.1% (26/108) vs 8.8% (31/352), χ(2) = 17.74, P0.01) and most of them come from the middle and high-level entertainmens (78.7% (85/108) vs 65.1% (229/352), χ(2) = 13.09, P0.01). Among the new-type drug-abusing FSWs, the prevalence rates of syphilis and HSV-2 were 12.0% (13/108) and 55.6% (60/108) , respectively. A total of 33 FSWs claimed that they were diagnosed with STDs in the recent year (30.6%) . The rates of syphilis(12.0% (13/108) vs 4.0% (14/352), χ(2) = 9.72, P0.01), HSV-2(55.6% (60/108) vs 39.2% (138/352), χ(2) = 9.01, P0.01) and diagnosed STDs (30.6% (33/108) vs 17.9% (63/352), χ(2) = 8.02, P0.01) among the drug-abusing FSWs were significantly higher than those of non-drug-abusing FSWs.There is a higher proportion of new-type drug abuse among the FSWs in Jiaozhou, with significantly higher prevalence rates of syphilis and HSV-2 infection, compared with non-new types of drug abusing FSWs. Prevalent risk sexual behaviors and ignorance of new-types drugs' harm were seen among them.

To analyze the prevalence rates and associated risk factors on HIV, syphilis, herpes simplex virus-2 (HSV-2) among female sex workers (FSWs) in Jiaozhou, Shandong province.Through convenient sampling, an anonymous questionnaire survey was conducted on female sex workers to collect related information. Blood specimens were drawn for serological tests on HIV, syphilis and HSV-2 antibodies, respectively. Patients with positive results from both treponema pallidum and HSV-2 tested by ELISA method, were defined as being superinfected.A total of 460 FSWs were recruited in this study. The prevalence rates of HIV, syphilis, HSV-2, and syphilis/HSV-2 superinfection were 0.22% , 5.9% , 43.0% , and 11.7% , respectively. Among the methamphetamine users, the prevalence rates of syphilis, HSV-2, and syphilis/HSV-2 superinfection were 12.4%, 55.2%, and 22.9%, respectively. Results from multivariate analysis showed that factors that significantly associated with syphilis infection would include: methamphetamine use (OR = 3.61, 95% CI:1.62-8.06), having first commercial sex intercourse at under 20 years of age (OR = 2.80, 95% CI:1.15-6.85), more than 2 establishments that the FSWs worked in the last month (OR = 4.37, 95%CI:0.83-22.83). Factors associated with HSV-2 infection were methamphetamine use (OR = 2.30, 95%CI:1.43-3.70), having first commercial sex intercourse at under 20 years of age (OR = 1.77, 95% CI:1.16-2.69), working at low-end establishments (OR = 2.61, 95%CI:1.66-4.10), working at the local sex-work venues for more than one year (OR = 2.01, 95% CI:1.28-3.14), with low education backgrounds (OR = 2.27, 95% CI:1.18-4.36), using methamphetamine (OR = 3.95, 95% CI:2.09-7.44), low education background (OR = 2.43, 95% CI: 1.10-5.36), 21-30 year-olds (OR = 2.95, 95%CI:1.08-8.03), older than 31 years of age (OR = 7.05, 95% CI:2.48-20.01) etc., were independent risk factors associated with the superinfection of syphilis and HSV-2.The prevalence rates of syphilis, HSV-2 and syphilis/HSV-2 superinfection were relatively high among FSWs in Jiaozhou, especially among the FSWs who were methamphetamine users.

The HIV epidemic continues to develop among older adults in China, including older female sex workers. Yet, few studies have been conducted among this relatively hidden population. The objectives of this study were to investigate the reasons for women's entry into sex work during their thirties and to develop typology of older women sex workers. Semi-structured in-depth interviews with sixty-three older women sex workers and six focus groups interviews with stakeholders were conducted in three cities in China in 2012. Data were analysed inductively using constant comparative method. The mean age of participants was 43 years old and the mean age of entry into sex work was 39 years old. The primary reasons for entry into sex work include heavy economic burdens, limited employment opportunities, and the appealing nature of sex work. Street-based and venue-based older sex workers were identified based on where they solicited clients. Street-based older sex workers were more likely to engage in unsafe commercial sex due to financial incentives, whereas those in entertainment venues were unlikely to use condoms with regular clients. The development of effective HIV interventions needs to consider older women sex workers unique characteristics and target factors that impede safer sex practices.

Background The availability of oral fluid HIV rapid testing provides an approach that may have the potential to expand HIV testing in China, especially among most-a-risk populations. There are few investigations about the acceptability of oral fluid HIV testing among most-at-risk populations in China. Method A cross-sectional study with men who have sex with men (MSM), female sex workers (FSW) and voluntary counseling and testing (VCT) clients was conducted in three cities of Shandong province, China from 2011 to 2012. Data were collected by face-to-face questionnaire. Results About 71% of participants were willing to accept the oral fluid HIV rapid testing, and home HIV testing was independently associated with acceptability of the new testing method among MSM, FSW and VCT clients (AOR of 4.46, 3.19 and 5.74, respectively). Independent predictors of oral fluid HIV rapid testing acceptability among MSM were having ever taken an oral fluid HIV rapid test (AOR= 15.25), having ever taken an HIV test (AOR= 2.07), and education level (AOR= 1.74). Engagement in HIV-related risk behaviors (AOR= 1.68) was an independent predictor of acceptability for FSW. Having taken an HIV test (AOR= 2.85) was an independent predictor of acceptability for VCT clients. The primary concern about the oral fluid HIV testing was accuracy. The median price they would pay for the testing ranged from 4.8 to 8.1 U.S. dollars. Conclusion High acceptability of oral fluid HIV rapid testing was shown among most-at-risk populations. Findings provide support for oral rapid HIV testing as another HIV prevention tool, and provide a backdrop for the implementation of HIV home testing in the near future. Appropriate pricing and increased public education through awareness campaigns that address concerns about the accuracy and safety of the oral fluid HIV rapid testing may help increase acceptability and use among most-at-risk populations in China.

A study of female sex workers in China, found alarmingly high prevalence of methamphetamine use. Methamphetamine users were more likely to be single, younger, inconsistent condom users, and have syphilis.