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1.
Lan Wei Xing Lu Hao Li Chenli Zheng Guilian Li Zhengrong Yang Lin Chen Jinquan Cheng Hui Wang Jin Zhao 《Lancet》2018
Background
CRF55_01B, a newly identified HIV-1 circulating recombinant form (CRF) with a backbone of CRF01_AE, originated from men who have sex with men (MSM) and can be traced back to 2005 in Shenzhen, China. Circulating primarily among MSM, it has now spread throughout most provinces of China with a prevalence ranging from 1·5% to 12·5%. However, its impact on the progression of disease has not been investigated.Methods
MSM with newly diagnosed HIV-1 (n=3418) were screened for HIV-1 genotypes from 2005 to 2015 in Shenzhen, China. Blood samples were collected for measurements of CD4 T-cell counts and viral load at the time of HIV diagnosis and initiation of combination antiretroviral therapy (cART). HIV-1 pol genes were sequenced and the subtype identified, and recent infection was defined as pol with less than 0·5% ambiguous nucleotides. Written informed consent was obtained from all of the participants. The protocol for recruitment was approved by the human subject committee of the Shenzhen Center for Disease Control and Prevention. Generalized linear regression models were applied to examine the relationship between viral subtype and the change rate of CD4 counts and viral load, with adjustments for confounding variables.Findings
Of the 2423 blood samples screened for genotypes, 1031 (42·3%) were CRF07_BC, 841 (34·7%) were CRF01_AE, 323 (13·3%) were CRF55_01B, 166 (6·9%) were subtype B, and 62 (2·6%) were other subtypes (eg, CRF_08BC, CRF59_01B, and C). CRF55_01B has replaced subtype B as the third most predominant strain in Shenzhen since 2012. Among the 1792 recent infections with the three main subtypes, those infected with CRF55_01B showed a significantly higher median viral load (5·4 [IQR 5·0, 5·9]) than CRF01_AE (5·3 [IQR 4·8, 5·7], P<0·01) and CRF07_BC (5·0 [IQR 4·5, 5·5], p<0·05) at the time of cART initiation. In terms of CD4 counts, CRF55_01B-infected (349·5 [IQR 250·2, 474·8]) MSM had a similar median to CRF01_AE-infected MSM (335·0 [IQR 237·0, 464·0], p=0·352), but a significantly lower median than CRF07_BC-infected (370·0, [IQR 278·0, 501·0], p<0·05) MSM at the time of diagnosis. Furthermore, CRF55_01B infection was associated with a significantly faster rate of increase of viral load than CRF07_BC infection (2·1 vs 0·7 log copies per ml per year, p<0·01). Furthermore, it showed a slower rate of decline of CD4 T-cell counts than CRF01_AE (13·6 vs 23·3 [cells per μL]1/2 per year, p<0·05) when the initial CD4 counts were between 200 and 350 cells per μL.Interpretation
It is well known that CRF01_AE leads to higher viral loads than CRF07_BC. However, our study revealed that CRF55_01B induced even higher viral loads than CRF01_AE, and thus the transmission risk of CRF55_01B may be higher than for CRF01_AE and CRF07_BC. Although CRF55_01B showed similar CD4 counts to CRF01_AE, the rate of decline of CD4 T-cell counts was slower, which may translate to a prolonged asymptomatic state. These findings help to explain the rapid increase in prevalence of CRF55_01B in China in recent years. Strengthened surveillance, tailored prevention plans and interventions, and in-depth research focusing on CRF55_01B are needed urgently to forestall a potential epidemic.Funding
This work was supported by the National Natural Science Foundation of China (81573211), the Shenzhen Municipal Technological Project (JCYJ20160331173336891) and the Shenzhen San-Ming Project of Medicine in Shenzhen (SZSM201811071). 相似文献2.
Chuncheng Liu Ye Zhang Stephen W Pan Dan Wu Bolin Cao Rong Fu Chongyi Wei Joseph D Tucker Weiming Tang 《Lancet》2017
Background
HIV-related stigma has been positively associated with low health-care utilisation and risky sexual behaviours in people living with HIV. However, the relationship between HIV-related stigma and the use of new technologies such as gay mobile applications and HIV self-testing is still not clear. We aimed to examine factors associated with HIV-anticipated stigma among men who have sex with men (MSM) and transgender individuals in China.Methods
During July 28–31, 2016, MSM and transgender individuals aged 16 years or older who self-reported as HIV negative were recruited for an online cross-sectional survey on China's biggest MSM mobile application BlueD. Information regarding sociodemographics, sexual behaviours, sexual health service use, and anticipated HIV stigma (measured by a seven-item Likert scale, ranging from one to four) were collected. The mean values of the seven items were calculated to create an overall score, with a higher score indicating a higher level of anticipated HIV stigma. Univariate and multivariable linear regressions were conducted to examine the factors associated with anticipated HIV stigma, while age, education, income, sexual orientation, and marital status were adjusted in the multivariable models.Findings
2006 participants were recruited; most were MSM (1904 of 2006, 95%). The mean score for anticipated HIV stigma was 2·98 (SD 0·64). Having used social media platforms to seek sexual partners within in the past 3 months (adjusted β 0·11, 95% CI 0·05–0·17) was associated with increased anticipated HIV stigma, whereas having self-tested for HIV (adjusted β ?0·07, 95% CI ?0·13 to ?0·01), and having disclosed one's sexuality to one's health-care provider (adjusted β ?0·16, 95% CI ?0·22 to ?0·96) were associated with decreased anticipated HIV stigma.Interpretation
Campaigns to combat HIV-related stigma are needed on gay mobile applications. Promotion of HIV self-testing and disclosure might be an effective method to reduce HIV-related stigma among MSM and transgender individuals in China.Funding
National Institutes of Health (National Institute of Allergy and Infectious Diseases [NIAID] 1R01AI114310; National Center for Advancing Translational Sciences [UL1TR001111]), University of North Carolina–South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), University of North Carolina Center for AIDS Research (NIAID 5P30AI050410), University of California San Francisco Center for AIDS Research (NIAID P30 AI027763), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138). 相似文献3.
Background
Data from national HIV sentinel surveillance are limited for men who have sex with men (MSM) about how geographical differences and sexual behaviours in this population are associated with prevalence of HIV infection in China. Through mapping, we aimed to clarify the pattern of HIV infections in different regions by conducting a spatiotemporal meta-analysis.Methods
We searched in PubMed and China National Knowledge Infrastructure (CNKI) using the key words “HIV”, “MSM”, “Gay”, and “China” for any studies with original data of HIV infection, which were conducted in mainland China between Jan 1, 2001, to June 8, 2016 and published in Chinese or English. Study area, study period, and sample size were included. We extracted key information on HIV and syphilis prevalence and on sexual behaviours. All studies were grouped by six study regions and four study periods. The meta-analysis was done with the meta package of R statistical software version 3.3.1.Findings
Overall, of 2119 papers screened, 272 papers were included in the meta-analysis. Of these selected papers, 83 (31%) were from east region. The sample sizes of the studies ranged from 19 to 47?231. National HIV prevalence increased from 3·80% (95% CI 3·03–4·76) in 2001–07 to 6·61% (5·65–7·71) in 2013–15. Southwest remained the region with the highest HIV prevalence (median 2001–07: 10·58%, 2008–10: 7·87%, 2011–12: 9·05%, and 2013–15: 9·23%), while northwest increased steeply to the same level as southwest over the years (median 2001–07: 5·30%, 2008–10: 4·72%, 2011–12: 6·64%, 2013–15: 9·45%). Syphilis prevalence progressively decreased across the study period from 12·34% (10·16–14·92) in 2001–07 to 7·09% (5·59–8·94) in 2013–15, the largest declines were observed in the southwest and northwest regions. There was a negative association between HIV infection and condom use with a male partner in the past month (r=–0·411, p=0·024) in 2008–15, but we did not find a significant correlation between syphilis and HIV prevalence, and between syphilis prevalence and sexual behaviours.Interpretation
The overall HIV prevalence is still increasing in China, particularly in the southwest and northwest regions. A strategy for prevention and control of HIV, especially for condom promotion, is highly expected.Funding
National Institutes of Health (National Institute of Allergy and Infectious Diseases [NIAID] 1R01AI114310); University of North Carolina (UNC)-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532); UNC Center for AIDS Research (NIAID 5P30AI050410); the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138); and National Center for Advancing Translational Sciences (UL1TR001111) at the National Institutes of Health. The listed grant funders had no role in any step of this study. 相似文献4.
Peizhen Zhao Ye Zhang Bolin Cao Chuncheng Liu Cheng Wang Shujie Huang Bin Yang Chongyi Wei Joseph D Tucker Weiming Tang 《Lancet》2017
Background
Increased HIV testing is an effective strategy for HIV control among key populations, including men who have sex with men (MSM). We aimed to examine the interaction between social norms related to HIV testing and self-efficacy of HIV testing among Chinese MSM.Methods
A cross-sectional online survey was conducted in eight Chinese cities in Shandong and Guangdong provinces in July 28–31, 2016. The inclusion criteria included: born as a male, age at least 16 years old, ever engaged in anal sex with men, and currently living in one of the designated cities. Information regarding sociodemographics, risk behaviours, and testing history for HIV and other sexually transmitted infections were collected. Social norm was operationalised by six items asking participants about the social norms of HIV testing. HIV testing self-efficacy was measured with a six-item scale. Higher mean scores indicated higher self-reported strength of social norms and self-efficacy for HIV testing. Univariate and multivariate logistic regressions were used to evaluate the interaction between self-efficacy and social norm on HIV testing.Findings
2105 men completed the survey. The mean age of the participants was 25·97 years (SD 6·42). More than four-fifths (1809 [86%]) of participants were unmarried, 477 (23%) were students, and 1359 (65%) had at least a college degree. Overall, 1315 (62%) participants had been ever tested for HIV, and 687 (33%) had been tested in the past 3 months. 685 (33%) had ever HIV self-tested in their lifetime. The main effect estimate on HIV testing in the past 3 months was 1·01 (95% CI 0·96–1·06) for social norm and 1·09 (95% CI 1·05–1·14) for self-efficacy, with an interaction effect of 1·02 (95% CI 1·01–1·03).Interpretation
Our survey demonstrated the interaction between self-efficacy and social norm on HIV testing among Chinese MSM. Further research and interventions to increase self-efficacy and social norm on HIV testing are needed.Funding
National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310; National Center for Advancing Translational Sciences grant number UL1TR001111), UNC-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), UNC Center for AIDS Research (National Institute of Allergy and Infectious Diseases 5P30AI050410), University of California San Francisco Center for AIDS Research (National Institute of Allergy and Infectious Diseases P30 AI027763), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138). 相似文献5.
Background
Childhood sexual abuse is associated with HIV vulnerabilities and psychological distress. Research indicates that childhood sexual abuse is also more common among sexual minorities. However, there is limited research into childhood sexual abuse among sexual minorities in China. We describe the prevalence and correlates of penetrative childhood sexual abuse among men who have sex with men (MSM) in urban north China.Methods
Data were collected from July 4, 2013, to March 23, 2014, by anonymous, self-administered, structured questionnaires at MSM HIV testing clinics in Beijing and Tianjin, China. Participants were also recruited via peer referral, gay websites, and community-based organisations. Penetrative childhood sexual abuse was defined as being forced to have sex with someone before age 16 years. Logistic regression was used to assess measures of association. Study protocols were reviewed and approved by the National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, and the Providence Health Care Research Institute, University of British Columbia.Findings
Out of 400 respondents, the prevalence of penetrative childhood sexual abuse was 5% (20/400). Median age at experience of penetrative childhood sexual abuse was 13 years (IQR 5 years). 85% (17/20) of perpetrators were older than the survivor (on average older by 7·5 years [SD 5·34]). Median length of relationship between the perpetrator and survivor was 3 months (IQR 24 months). Penetrative childhood sexual abuse was associated with migrant status (crude odds ratio [cOR] 3·65, 95% CI 1·04–12·55) and living with one's wife (4·09, 1·25–13·41). Pre-teen penetrative childhood sexual abuse was associated with Christian religious affiliation (cOR 7·24, 95% CI 1·40–37·30), particularly Catholic religious affiliation (11·71, 1·08–127·16). No significant associations were detected between penetrative childhood sexual abuse and HIV infection, unprotected sex, depression, or anxiety.Interpretation
We found that prevalence of penetrative childhood sexual abuse among urban Chinese MSM in urban North China was lower than in studies among MSM in North America, but higher than studies among Chinese males overall. These findings could help inform interventions to decrease childhood sexual abuse among sexual minority males in China.Funding
Ministry of Science and Technology of China (2012ZX10004-904), the US Fulbright Program, and the Liu Institute for Global Issues. 相似文献6.
Background
The rapid transmission and potential link to severe neurologica complications and birth defects have made Zika virus infection a serious threat to global public health. However, the initial ancestor of Zika virus and the potential transmission route remain are unknown.Methods
We assessed the epidemiological characteristics of 28 confirmed cases of Zika virus infection and analysed the genetic diversity of Zika virus isolates.Findings
28 confirmed cases of Zika virus infection were imported from South America, Central America and south Pacific areas. 18 cases were overseas Chinese people who had emigrated from Jiangmen, Guangdong. The remaining cases were businessman travelling in Venezuela, Samoa, Suriname, Guatemala, and Ecuador. The results of a molecular-clock phylogenetic analysis showed that the evolutionary rate of the Asian lineage was 1·05?×?10?3 substitutions per site per year. The estimated time-scaled phylogeny contains a well-supported cluster of Zika virus strains (posterior probability [PP]=1·0) that share a common ancestor with the French Polynesia lineage in 2013, which suggests that a common ancestor likely transmitted from French Polynesia to South America, particularly to Brazil. All cases of Zika virus imported into China were located in two independent clusters (PP=1·0). One cluster contained the isolates imported into China from Venezuela. The common ancestor of this clade descended from an ancestral lineage that can be dated to the beginning of 2015; therefore, the imported China isolates from Venezuela were probably already locally endemic before 2015. In another cluster, all the isolates were imported into China from the South Pacific island Samoa. The common ancestor of this cluster can be dated to the middle of 2014. The estimated time-scaled phylogeny indicates that this cluster also shared a common ancestor with French Polynesia strain in 2013 (PP=0·99).Interpretation
The present data indicated that the imported Zika virus in China was unlikely to be transmitted from Brazil in 2015. Alternatively, an independent local transmission of Zika virus appears to have been previously established in Venezuela and Samoa after 2014 and 2013, respectively.Funding
Guangdong Provincial Science and Technology Program (2015A020213004), Guangdong Provincial Science and Technology (2016A020251001), and National Key R&D Program (2016YFC1200201). 相似文献7.
目的了解沈阳市男男性行为人群（MSM）艾滋病病毒（HIV）感染率及其影响因素,进一步做好MSM的艾滋病防治工作。方法采用同伴推动法（RDS）招募900名MSM,由经过专业培训的调查员进行面对面的问卷调查,主要内容包括社会人口学特征、艾滋病知识知晓水平、性行为状况、接受干预服务情况和HIV/梅毒感染状况,并抽取静脉血检测HIV及梅毒,对影响HIV感染的相关因素进行χ2检验。结果调查了900名MSM,艾滋病知识知晓率达到91.3%。86.9%的调查对象最近6个月有同性肛交性行为,最近6个月与男性发生肛交性行为时每次都使用安全套的比例为57.5%。HIV感染率为9.3%,梅毒感染率为11.0%。分析显示,年龄较大、文化程度在初中及以下、最近6个月与男性发生肛交性行为时未坚持使用安全套、梅毒感染是感染HIV的危险因素。结论 MSM人群高危性行为发生率、HIV和梅毒感染率均高,可能成为当前HIV流行的重要人群和重要因素,应采取积极有效的宣传教育和行为干预活动。 相似文献
8.
Gregory Phillips II Manya Magnus Irene Kuo Katharine D. Shelley Anthony Rawls Tiffany West-Ojo 《AIDS care》2013,25(12):1481-1484
In Washington, DC, the leading mode of HIV transmission is through men who have sex with men (MSM) behavior. This study explored differences between frequent HIV testers (men testing at least twice a year) and annual or less frequent testers (men testing once a year or less) in DC. Nearly, one-third of MSM reported testing for HIV at least four times in the prior two years. In the multivariable model, frequent testers had significantly higher odds of being aged 18–34 (aOR =1.94), knowing their last partner's HIV status (aOR=1.86), having 5+ partners in the last year (aOR=1.52), and having seen a health-care provider in the last year (aOR=2.28). Conversely, frequent testers had significantly lower odds of being newly HIV positive (aOR=0.27), and having a main partner at last sex (vs. casual/exchange partner; aOR=0.59). Medical providers need to be encouraged to consistently offer an HIV test to their patients, especially those who are sexually active and who have not tested recently. 相似文献
9.
10.
Jason J Ong Haochu Li Wu Dan Hongyun Fu Ewen Liu Wei Ma Demin Kang Meizhen Liao Gifty Marley Chongyi Wei Weiming Tang Stephen Pan Chuncheng Liu Bin Yang Ligang Yang Shujie Huang Joseph D Tucker 《Lancet》2017
Background
The wide range of interventions to promote HIV testing might inadvertently contribute to coerced testing. There has been concern about coerced HIV self-testing in non-research settings where there is minimal supervision. The aim of this study was to examine the prevalence and correlates of coerced HIV testing among men who have sex with men (MSM) in China.Methods
In July 2016, we recruited MSM from eight cities through BlueD, a gay social network mobile application. Data on sociodemographics, HIV self-testing, HIV facility testing, test coercion, condomless sex in the past 3 months, and transactional sex were collected. Coerced testing was defined as someone (partner, friend, employer, or others) forcing the participant to take an HIV test. Multivariable logistic regression was used to examine correlates of coerced testing among MSM who had ever received HIV testing.Findings
1312 men were included, most of whom were young (mean age 26·9 years [SD 6·3]). 1002 (76%) men were identified as gay, and 685 (52%) men had used HIV self-testing. 64 (15%) men reported coerced testing, and 39 of these men were forced to have a self-test. Adjusting for age, education, income, and residence, men who reported coerced testing were more likely to have ever self-tested for HIV (adjusted odds ratio 4·25; 95% CI 2·23–8·09). Coerced testing was more common among men who had sex with casual partners in exchange for gifts or money (3·34; 1·90–5·86) than among men who did not report transactional sex. Coerced testing was also more common among MSM who reported condomless anal sex in the preceding 3 months (2·38; 1·43–3·98) than among men who did not report condomless anal sex.Interpretation
HIV test coercion is uncommon among MSM in China, but is more likely in men who used HIV self-tests. As HIV self-testing is scaled up worldwide, research and enhanced post-test surveillance are needed.Funding
National Institute of Allergy and Infectious Diseases (1R01AI114310-01) and the Australian National Health Medical Research Council (APP1104781). The funders had no role in the design of the study, the collection, analysis, and interpretation of data, or in the writing of the Abstract. 相似文献11.
Background
With the rapid pace of population ageing, tuberculosis in older people has become a public health challenge in China. However, the age-structured epidemiological transition and its impact on achieving the end tuberculosis targets by 2035 have not been understood well. We analysed the age-structured incidence and mortality of pulmonary tuberculosis reported in China to inform current and future control programmes.Methods
In this longitudinal study, we compared the trends of age-specific reported incidence and mortality of pulmonary tuberculosis from 2005 to 2015 in China. In addition to crude rates, we calculated age-adjusted rates from 2006 to 2015 by taking the population in 2005 as reference. We determined the annual crude and age-adjusted rates of reduction by fitting an exponential linear regression model, and extrapolated up to 2035 given fixed decline rates. All data were collected from national Infectious Disease Reporting System and Diseases Surveillance System.Findings
We noted overall downward trends of reported tuberculosis incidence and mortality in all age and sex groups since 2005, whereas the proportion of older people (aged 65 years and older) among reported patients with tuberculosis and deaths increased gradually. The total tuberculosis incidence and mortality were significantly higher in older people (193·0 cases per 100?000 people and 18·7 deaths per 100?000 people, respectively) than in younger groups (66·6 cases per 100?000 and 1·7 deaths per 100?000 people). The average annual decline in crude incidence was 4·2% (95% CI 3·5–4·9) and 5·1% (4·3–5·9%) in age-adjusted incidence; the annual decline in crude mortality was 9·7% (95% CI 8·4–10·9) and 12·4% (10·9–13·8) in age-adjusted mortality. Extrapolating this trend, by 2035, the crude incidence of tuberculosis was expected to reach 26·8 cases per 100?000 people and the age-adjusted incidence to reach 20·6 cases per 100?000 people, which would result in a total reduction of 57·8% and 65·0%, respectively, compared with the rates in 2015. By 2035, the crude mortality was expected to reach 0·33 deaths per 100?000 people and the age-adjusted mortality to reach 0·15 deaths per 100?000 people, which would result in a total reduction of 86·0% and 92·0%, respectively, compared with the rates in 2015.Interpretation
These findings demonstrated an age transition of tuberculosis epidemic and the effects of population ageing on slowing down tuberculosis control progress made in China. An average 6–7% reduction would be cancelled out by 2035 given current tuberculosis decline trend and demographic change. An enhanced surveillance with age-sensitive analysis of patients with tuberculosis and a targeted response are needed.Funding
None. 相似文献12.
13.
Joshua Brian Mendelsohn Hua Cheng Liviana Calzavara Susan Wang Sandra Bullock Sharmistha Mishra Ann Burchell Mona Loutfy Alan Li Robert Hogg Sarah Jane Steele Rahim Moineddin Laiyi Kang 《Lancet》2018
Background
There is a growing HIV epidemic among key populations in China, including men who have sex with men (MSM), and rural-to-urban migrants. In Shanghai, new HIV infections among these groups are increasing. In June 2016, a test-and-treat policy was adopted; residents of Shanghai are now offered antiretroviral therapy (ART) immediately after diagnosis. We aimed to clarify the challenges of implementation and the potential impact of the test-and-treat policy by reviewing 10 years of surveillance data prior to the rollout of the test-and-treat programme.Methods
We used pre-ART and ART surveillance databases from 2006 to 2016 to quantify annual proportions of individuals with newly diagnosed HIV linking to care (the percentage completing the first CD4 test), initiating ART (the percentage starting ART, of those linked to care), and viral suppression (the percentage with a viral load of <50 copies per mL, of those initiating ART).Findings
Data were extracted for individuals diagnosed with HIV during the surveillance period (13?637 individuals), including 7267 MSM and 11?156 migrants. Overall, 89% were male, 53% of infections were reported as same-sex transmissions, 69% were under 39 years old, and 27% were married. Averaging across the surveillance period, 77%, 59%, and 26% of MSM, and 66%, 52%, and 27% of migrants were linked to care, had initiated ART, and were virally suppressed, respectively. Proportions virally suppressed did not include 70% of MSM and 68% of migrants with an unknown viral load in the year of HIV diagnosis.Interpretation
In the 10-year period preceding the new test-and-treat policy, gaps were apparent in the proportions of MSM and migrants with HIV who were receiving care, who had commenced ART, and who were virally suppressed. To increase the impact of the test-and-treat programme, the proportion of individuals with newly diagnosed HIV initiating ART in future should exceed the proportion identified here. Viral load tests should be routinely carried out within 1 year of ART initiation. A prospective cohort study has been established to help to explain these gaps by evaluating the test-and-treat programme and modelling its impact on future HIV transmission.Funding
Canadian Institutes of Health Research. 相似文献14.
15.
Chongyi Wei Hongjing Yan Chuankun Yang H. Fisher Raymond Jianjun Li Haitao Yang 《AIDS care》2014,26(3):372-378
Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed. 相似文献
16.
17.
HIV remains concentrated among men who have sex with men (MSM) in Peru, and homophobia and AIDS-related stigmas have kept the epidemic difficult to address. Gay self-identity has been associated with increased HIV testing, though this relationship has not been examined extensively. Social media use has been rapidly increasing in Peru, yet little is known about MSM social media users in Peru. This study sought to investigate the demographic, behavioral, and stigma-related factors associated with HIV testing among social media-using Peruvian MSM. Five hundred and fifty-six MSM from Lima and surrounding areas were recruited from social networking websites to complete a survey on their sexual risk behaviors. We examined the demographic and social correlates of HIV testing behavior among this sample. Younger age and non-gay identity were significantly associated with lower likelihood of getting tested in univariate analysis. After controlling for key behaviors and AIDS-related stigma, younger age remained significantly associated with decreased testing. Participants who engaged in discussions online about HIV testing were more likely to get tested, while AIDS-related stigma presented a significant barrier to testing. Stigma severity also varied significantly by sexual identity. Youth appear to be significantly less likely than older individuals to test for HIV. Among Peruvian MSM, AIDS-related stigma remains a strong predictor of willingness to get tested. Social media-based intervention work targeting Peruvian youth should encourage discussion around HIV testing, and must also address AIDS-related stigma. 相似文献
18.
Weibin Cheng Huifang Xu Sharon Stucker Weir Stephen Pan Fei Zhong Joseph D Tucker Weiming Tang Jinkou Zhao 《Lancet》2017
Background
Timely monitoring of the HIV epidemic among key populations is a formidable challenge. We aimed to compare data collected from an integrated HIV biobehavioural surveillance plus (IBBS+) system and general HIV testing programmes to evaluate whether data from HIV testing programmes are suitable for surveillance purposes.Methods
The IBBS+ data were collected from HIV sentinel surveillance conducted from 2009 to 2013 between April and July of each year in Guangzhou, China, while HIV testing programme data were collected from the China-Gates HIV Program during the same years from September to December. We evaluated the demographic characteristics, condom use, HIV testing history, and the HIV positive rate among men who have sex with men (MSM) in these two datasets. We used the Armitage-trend test to evaluate the HIV positive rates and behaviours of the participants in the two datasets over the study period.Findings
2224 MSM were included in the IBBS+ dataset and 5311 were included in the HIV testing programme dataset. Most participants in the two datasets were aged 20–29 years, had at least college-level educational attainment, and had never been married. However, sociodemographic characteristics varied slightly between the two datasets (for example, participants in the testing service sample were younger and more likely to be unmarried). The IBBS+ indicated that MSM HIV prevalence increased from 3·9% in 2009 to 11·4% in 2013 (ptrend<0·0001), while data from the HIV testing programme indicated that the MSM HIV positive rate during the same period increased from 6·2% to 8·9% (ptrend=0·041). Condom use at last anal intercourse remained consistent and comparable between the two datasets throughout the study period, ranging from 65·8% to 71·1% in IBBS+ (ptrend=0·170) and 64·7% to 70·4% in the HIV testing programme (ptrend=0·053).Interpretation
Routinely collected data from HIV testing programmes seem to complement existing biological and behavioural surveillance systems for HIV in MSM in China. Resource-limited settings without IBBS can consider using HIV testing programmatic data to monitor trends in HIV prevalence and riskier behaviours of key populations.Funding
National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310), UNC-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), UNC Center for AIDS Research (National Institute of Allergy and Infectious Diseases 5P30AI050410), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138). 相似文献19.
Kate S Baker Timothy J Dallman Nigel Field Tristan Childs John Were Gwenda Hughes Claire Jenkins Nicholas R Thomson 《Lancet》2017
Background
In high-income nations, men who have sex with men (MSM) are at increased risk of shigellosis. A sublineage of Shigella flexneri serotype 3a was recently shown to have spread worldwide in MSM, driven by mobilisable azithromycin resistance. Since then, the serotype 2a and the species S sonnei have become epidemic in the UK. We aimed to determine whether these subsequent outbreaks were also attributable to epidemic sublineages in MSM and mobilisable antimicrobial resistance.Methods
We applied whole-genome sequencing to a random cross-section of S flexneri 2a (n=176) and S sonnei (n=188) isolates submitted to the UK national reference laboratory between 2004 and 2014 (10% and 2% of travel-associated and 20% and 10% of domestically acquired cases, respectively). Phylogenetic analysis and patient data (date of illness, age, sex, travel history) were combined to identify potential MSM-associated sublineages, and antimicrobial resistance determinants were compared among S sonnei, S flexneri 2a, and pandemic S flexneri 3a.Findings
Shorter phylogenetic distances (more closely related isolates) were statistically associated with male–male patient pairs for both S sonnei and S flexneri 2a. For S flexneri 2a, this association manifested as a single low-diversity sublineage containing 47 of 176 isolates collected over the epidemic window (2012–2014) mainly (43 of the 47 isolates) from 16–60-year-old male patients without recent travel. This lineage was associated with azithromycin resistance (odds ratio 25·8, p<0·0001) carried by an antimicrobial resistance determinant identical to that found in the pandemic S flexneri 3a sublineage. For S sonnei there were multiple low-diversity sublineages with similar patient profiles, some of which were associated with this azithromycin resistance determinant.Interpretation
These results suggest that outbreaks of S flexneri 2a and S sonnei were associated with MSM. The mobilisation of azithromycin resistance between S flexneri 3a, S flexneri 2a, and S sonnei indicates that antimicrobial resistance has a role in driving these epidemic waves. The presence of a single resistance determinant associated with all three epidemics suggests that future antimicrobial resistance surveillance might be enhanced by focusing at the level of genetic determinants rather than pathogens.Funding
Wellcome Trust, Public Health England. 相似文献20.
男男性行为人群（MSM）中存在的多性伴、非保护性性行为、饮酒和毒品使用等,是造成艾滋病病毒（HIV）及性传播疾病（Sexual transmitted disease,STD）在该人群中传播的主要原因,应及时采取相应的干预措施。该人群随访率相对较高,有利于在该人群中开展深入的研究及实施干预。 相似文献