HIV and syphilis infections among street-based female sex workers in China, 2010–2012

Background Female sex workers （FSW） were high-risk population for HIV and other sexually transmitted diseases （STD） earlier,and now are an important driver of the HIV/AIDS epidemic in China.Sentinel surveillance for FSW was set up to monitor the trend of HIV prevalence and risk behavior-related HIV infection.This study collected the data on street-based FSW from HIV sentinel surveillance system to understand HIV and syphilis infections,risk behaviors,and intervention in China from 2010 to 2012.Methods The study population was the street-based FSW who were recruited for the national HIV integrated biological and behavioral surveillance between 2010 and 2012.Demographic information,HIV-related risk behaviors,and HIV and syphilis testing results were described and trend analysis was performed.Results Between 2010 and 2012,the number of street-based FSW surveyed was 3725,3425,and 3335,respectively.HIV knowledge awareness rate significantly increased from 74.6% in 2010 to 76.8% in 2011 and 82.2% in 2012 （P 〈0.01）.More FSW consistently used condom in the last month （49.0% in 2010; 51.0% in 2011; and 59.0% in 2012） and in the last commercial sex （72.0% in 2010; 78.5% in 2011; and 80.0% in 2012） over time.The proportions of individuals who received HIV testing in the last year were 31.2% （2010）,37.0% （2011）,and 36.9% （2012） （P-trend 〈0.01）.HIV prevalence rate changed from 1.5% in 2010 to 1.4% in 2011 and 2.3% in 2012 （P-trend=0.01）.Syphilis prevalence rate was 6.9%,7.2%,and 7.1% in the same period.The top three provinces with the highest average HIV prevalence rates over the 3 years were Guangxi （5.9%）,Yunnan （4.2%）,and Sichuan （1.2%）.Conclusions Street-based FSW are at high risk of HIV and syphilis infections.Intervention efforts need to target streetbased FSW who are of old age and minority,who use illicit drugs and have syphilis infection.     

Male Sex with Male： A Study of Commercial Sex Workers in Larkana,Pakistan, regarding Their Knowledge about HIV/AIDS ＆ STIs and Sexual Behavior

Objective To explore the knowledge of male commercial sex workers （MSM） Larkana, Pakistan, regarding HIV/AIDS ＆ STIs and their sexual behavior. Methods The cross-sectional study was conducted in December 2006 at district Larkana, Sindh Pakistan. The method used was ＂Random Sampling＂. It was conducted at all the 15 spots which included permanent and temporary locations of the MSM commercial sex activity. The study population comprised of about 120 MSM and at every MSM spot the sample was taken randomly. The semi-structured questionnaire was put to total 15of MSM workers. It was analyzed on MS Office and SPSS 11.0. Results The words of HIV/AIDS were ever heard only by 40% of MSM and 46.7% of them had the partial knowledge. About the routes of HIV/AIDS spread, 86.7% of them knew nothing. Those who were engaged in the sexual activity for more than 10 years, 91.6% of them did not know how HIV/AIDS does spread and 69.3% of these refused need of condom use for safe sexual practices. Moreover, 84.6% of those who had no knowledge about the HIV/AIDS said that they have no plan to quit the sexual activity; 86.7% of respondents did not know how HIV/AIDS does not spread; 86.7% of respondents did not know how HIV/AIDS can be detected; 86.7% of respondents did not know about treatment of HIV/AIDS. Regarding risk of the spread of STIs by the sexual activity, 60% of them told that they do not know about it; where as 33.3% of them were aware of it. And 75% of those who had no knowledge about STIs also expressed no need of condom use for safe sexual practice. Regarding condom use by customers during sexual act, 40% of the MSM said that they do not use; while 33.3% said that they seldom use the condom. Only 22.2% of the MSM requested their customers to use the condom. While 60% of the MSM denied the need for provision of condoms for safe sexual practice, 86.7% of them intended to be provided with more information about HIV/AIDS ＆ STIs. Answering the questions about details of customers/visitors, 86.7% of MSM told that they belonged to all age groups. Overwhelming majority of MSM maintained that they will never force customers to use condom. Conclusions The least or no knowledge regarding HIV/AIDS ＆ STIs and no intention for condom use or quitting the profession and that only in a small sample size in one city, presents a potential indication of worst situation for the transmission of HIV/AIDS and STIs. Given the condition, there is a dire need of an intervention for safe sexual practice and a justified and unprejudiced conduct by society.     

Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005–2006

Background Men who have sex with men （MSM） have become one of the most risky populations for HIV infection in China. Though several cross-sectional sero-prevalence studies have been conducted, the annual HIV incidence remains unknown in this population.
Methods We applied IgG-capture BED-enzyme immunoassay （BED-CEIA） to define the recent HIV-1 infections among MSM in Beijing in the years 2005 and 2006 and the annual HIV incidence was estimated.
Results Overall, 1067 MSM samples were collected, including 526 samples in the year 2005 and 541 in 2006. In 2005, of 17 HIV seropositive samples, 7 were identified as recent HIV-1 infections and the estimated HIV infection incidence was 2.9% per year （95% CI, 0.8%-5.0%）. In 2006, of 26 HIV seropositive samples, 9 were identified as recent HIV-1 infections and the estimated annual incidence was 3.6% （95% CI, 1.3%-5.9%）, which was 0.7% higher than that in 2005. Individuals engaging in male group sexual intercourse （5.17% vs 0.87%, P=0.019） and having receptive anal sexual intercourse more than five times （2.79% vs 0.33%, P=0.047） in the past 6 months significantly increase the risk of being infected by HIV-1.
Conclusions A high level of annual HIV-1 infection incidence was observed among MSM in Beijing for the consecutive years 2005 and 2006 with a continuous increasing trend. The rising incidence and related high risk behavior among MSM alarmed the health authorities and calls for more effective intervention strategies among this population.     

HIV prevalence and influencing factors analysis of sentinel surveillance among men who have sex with men in China, 2003–2011

Background  Men who have sex with men (MSM) have been impacted by HIV and now as an important driver of the HIV/AIDS epidemic in China. This study collected HIV sentinel surveillance system data on the MSM population to describe the characteristics and trends of the HIV epidemic among MSM in China from 2003 to 2011.

Methods  Data on HIV prevalence and risk behaviors from 2003 to 2011 were obtained from the national HIV sentinel surveillance database.

Results  MSM sentinel surveillance data for 2011 showed that proportions of MSM who consistently used condoms during anal sex in the last six months and at last anal sex encounter were 43.3% and 74.1%, respectively. Between 2005 and 2011 there were no significant changes in the proportion of consistent condom use. The proportion of MSM who had multiple male sex partners in the last six months increased. Overall HIV prevalence over the years showed a rising trend from 0.9% in 2003 to 6.3% in 2011. The syphilis antibody positive rate was 7.8% in 2011. In addition, the proportion of MSM in heterosexual marriages was rising, AIDS awareness was also increasing, and the proportion of MSM who had taken an HIV test in the last year and was aware of the results rose. The proportion who had received intervention services in the last year stabilized.

Conclusions  HIV prevalence in MSM populations is rapidly and widely distributed. MSM who are in heterosexual marriages may be a bridge group transmitting HIV to their heterosexual partners. The risky sexual behavior among MSM will remain a serious and important driver of China’s AIDS epidemic over the next period of time. Intervention need to be strengthened, as does the effective implementation of measures to control AIDS and prevent it from spreading further.

     

AIDS—related Knowledge,Condom Usage Among Medical Postgraduates

Objective To investigate the knowledge about safety/unsafty of sexual acts relating to HIV transmission, levels of embarrassment related to condom and condom usage among medical postgraduates. Methods From August to December, 1998, a self-administered anonymous questionnaire was given to 271 new medical postgraduates from two medical colleges of Beijing and Hebei Province. Results There was a hazy understanding of the protective function of condom from AIDS among medical postgraduates. Only 14.4% medical postgraduates persisted in using condom, and 27.94% had never or almost never used it. The levels of embarrassment about condom were high. The median score was 3.55+0.98. Whether to use condom was related with the attitudes to condom, but not to AIDS. Conclusion There was some misunderstanding about condom and inconsistent condom usage in medical postgraduates. So it is essential to strengthen the sexual health education among them.     

AIDS- Related Knowledge, Attitudes and Behavior Survey among the ＂Migrant＂ Population in China

Objective To realize AIDS related knowledge, attitude and behavior among floating people in China and discuss its influencial factors, and to provide the evidence for how to prevent AIDS in floating population. Methods The data were collected from the ＂Sex and Reproductive Health Baseline Survey among Floating People in China＂ conducted in March 2004. The standard questionnaires were used to interview altogether 4 900 floating people from 6 provinces. Results Nearly 95.4 % of them had heard about AIDS, but only 0.5% can judge all the transmitted ways and no-transmitted ways correctly, 45.9 % believed that we need to isolate the HIV positive people. Only 65.7% knew that using condom can preventive HIV infection, 43. 7% showed their understanding about the man who has long time no sexual life has sex with a sexual worker. About 13.6% floating people chose condom as FP method and among them only 34. 6% used condom every time. Conclusion Chinese floating people are lack of AIDS knowledge. Most of them do not practise Safe Sex Activity. We need to give more intervention to the floating population.     

HIV-infected Female Sex Workers High Risk Behavior and Attitude Changes in Kaiyuan City,Yunnan Province,China

Objective To investigate the attitude and sexual behavior status and change among HIV positive female workers in entertainment sites in Kaiyuan city, Yunnan province, China. The key information should be applied in the integrated intervention program in future.
Methods A cohort survey among HIV positive female workers was conducted during 12 months, between 2010 and 2012. All the risk sexual behavior and attitude were collected for assessment for the potential secondary transmission to sexual partners.
Results Of 99 HIV positive women who sell sex in Kaiyuan city, 99 participated in the survey at baseline, 80, 80, 75, and 75 at 3-, 6-, 9-, and 12-month follow-ups. The percentage of participants who reported consistently used condoms in the last one month ranged between 94.5% and 95.5%. The client volume in the last one month, income per sex and age group were significant related with non-insistent condom use with their clients.
Conclusion It was suggested that integrated intervention program package should include 100 percent condom use promotion for the HIV positive FSW with all sexual partners, and also, include socially support involved.     

Study on Perception of Potential Condom Use among Unmarried Migrants

Objective To understand the perception of potential condom use and its influencing factors so as to promote condom use among unmarried migrants Method A survey, using self-administered structured anonx‘mous questionnaire, was conducted among 1 092 unmarried migrants aged 15～24 years old in urban area of Shanghai. Results The unmarried migrants had some knowledge of condom. However, their knowledge level and their attitude towards condom use were not so optimistic. Subjects‘ knowledge of contraceptives and STD/AIDS had a positive influence on their attitude toward condom use. Subjects with positive attitude to condom use were more likely to use condom in sexual activity (OR=1.61). Conclusion Unmarried migrants have lower rate of condom use if they have insufficient knowledge of condom. Therefore, it is essential to strengthen the sexual health education among unmarried sex-active migrants in order to encourage contraceptive use, especially condom use.     

Study on Relationship between Reproductive Tract Infections and Personal Hygiene Behaviors among Vulnerable Married Women in Shanghai

Objective: To understand the influence of personal hygiene behaviors on reproductive tract infections (RTIs) and to provide evidence for the intervention among married women at childbearing age Methods : A total of 1 631 married women in 60 residence neighborhoods from 4 streets and 2 stagnant enterprises were selected by multistage cluster random sampling and interviewed face-to-face through questionnaires, laboratory tests assay and gynecological examination. All data were analyzed by SAS 8. 2. Results: The positive detection rates of five target pathogens, trichomonas vaginalis, candida albicans, G. vaginalis, chlamydia trachomatis and Neisseria gonorrhoeae, in the study were 3. 04%, 5. 04%, 1. 52%, 6. 68%, and 0. 12%, respectively. Personal hygiene practices and sexual behaviors among married women in the study were good in general. The vast majority of women ( 98. 77% ) rinsed their vulvae every day and more than half of the women (53. 03% ) took bath every day. In terms of the prevalence of endogenous infection, there were statistical differences between women who had different frequencies of rinsing their vuluae and taking bath ; and for the prevalence of sexually transmitted infection, there were significant differences between women whose husband had different frequency of washing their external genital organs before sexual intercourses each time. The mostly adopted contraceptive methods among women ranked by frequency were intra-uterine devices (IUD ) (68. 69%), male condom (16. 69%) and safe period (6. 20%), among which male condom could prevent sexually transmitted infections. Multiple logistic regression analyses indicated that the frequency of taking bath, the husband washing his external genital organ before sexual intercourse and the age of marriage were the influencing factors of RTIs, too. Conclusion :It is very urgent that health educational intervention of RTIs among married women be conducted and especially the knowledge on condom‘s double effects on contraception and prevention of RTIs be disseminated to urge women to practice hygiene behavior to achieve the aim of preventing RTIs.     

Preliminary research on the co-infection of human immunodeficiency virus and hepatitis virus in intravenous drug users

Objective To confirm the close relationship of high co-infection rate between HIV and hepatitis virus in intravenous drug users (IVDUs).Methods Anti-HIV, HBV and HCV were detected by ELISA in the serum from 35 scattered and 15massed IVDUs. PCR and RT-PCR were performed to confirm the infection of HIV, HBV, HCV, HGVand TTV among the 15 massed intravenous drug abusers.Results Among the 50 IVDUs, the positive rates of anti-HCVl HBsAg, anti-HBe and anti-HBc were 92% (46/50), 12% (6/50), 10% (5/50) and 66% (33/50), respectively. In the samples of HBsAg positive, their HBeAg was also positive. Although the positive rate of serum markers was different in the massed IVDUs compared to the scattered IVDUs, no significant difference was shown.In the cases of massed IVDUs, the positive rates of HIV DNA, HBV-DNA, HCV-RNA, HGV-RNA,and TTV-DNA were 100% (15/15), 26. 6% (4/15), 53. 3% (8/15), 33. 3% (5/15) and 26. 6%(4/15), respectively. Among the 15 massed intravenous drug users, one was infected with HIV,HBV, HCV, HGV and TTV; two were infected with HIV, HBV, HCV and HGV; three were infected only with HIV; and the remaining had other forms of co-infection.Conclusion The co-infection rate of HIV, HBV, HCV, HGV and TTV in intravenous drug users is very high.