Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China

OBJECTIVES: To address the role of men who have sex with men (MSM) in the human immunodeficiency virus (HIV)/sexually transmitted disease (STD) epidemic in China. GOAL: To explore the prevalence of risky sexual behaviors and the existing prevention efforts among men who have sex with men (MSM) in China. STUDY DESIGN: Review of behavioral and STD/HIV prevention studies addressing MSM in China. RESULTS: Sexual risk behaviors including unprotected group sex, anal sex, casual sex, and commercial sex were prevalent among Chinese MSM. Many Chinese MSM also engaged in unprotected sex with both men and women. Most MSM either did not perceive that they were at risk of HIV/AIDS or underestimated their risk of infection. Surveillance and intervention research among these men are still in the preliminary stages. CONCLUSIONS: Chinese MSM are at risk for HIV/STD infection and potential transmission of HIV to the general population. In addition to sexual risk reduction among MSM, reduction of homosexuality- related stigma should be part of effective intervention efforts. Volunteers from the MSM community and health care workers in primary health care system may serve as valuable resources for HIV/STD prevention and control among MSM.     

浙江省2011年新型毒品使用者艾滋病、梅毒和丙型肝炎感染状况及其危险行为特征分析

目的 了解浙江省新型毒品使用者艾滋病、梅毒和丙型肝炎(丙肝)感染水平、相关行为特征以及相互关系。方法 2011年在浙江省6个城市对戒毒人员进行匿名问卷调查,调查内容包括社会人口学、使用毒品种类、性行为、接受干预情况,并采集血液进行艾滋病、梅毒和丙肝抗体检测。利用SPSS 15.0统计软件进行数据分析。结果 共调查3 253人,其中新型毒品使用者1 298人,占39.9%,北部和中部地区、女性、≤25岁年龄组、浙江省户籍和有商业性性行为的吸毒者中使用新型毒品的比例较高。1 298例新型毒品使用者中,使用冰毒者占91.2%,HIV抗体阳性率为0.1%(95%CI:0.0%～0.2%),梅毒抗体阳性率为8.1%(95%CI:6.6%～9.6%),丙肝抗体阳性率为17.3%(95%CI:15.2%～19.4%);艾滋病知识知晓率为12.7%,有注射吸毒史者占9.2%,最近一年有商业性性行为者占29.6%。曾接受安全套发放和咨询的比例为33.4%,曾接受艾滋病检测的比例为14.0%。多因素分析表明,来自中部和南部地区的新型毒品使用者的梅毒感染、丙肝感染和有注射吸毒行为比例高于来自北部地区者;女性是梅毒感染的相关因素;曾注射吸毒和最近一年有商业性性行为与丙肝感染相互关联;曾注射吸毒行为与最近一年商业性性行为相互关联。男性、浙江省户籍及未接受过安全套发放和咨询者更有可能发生商业性性行为。结论 新型毒品使用者梅毒和丙肝感染水平高,不安全行为发生率高,接受干预服务比例低,提示需要提高对该人群的艾滋病、梅毒和丙肝感染风险的认识,设计制定针对该人群的有效干预措施,扩大干预覆盖率。     

Decision-Making in HIV Prevention Community Planning: An Integrative Review

Since 1994, the Centers for Disease Control and Prevention has required that the 65 health department grantees that receive funding for HIV prevention interventions engage in a community planning process to involve affected communities in local prevention decision making; to increase the use of epidemiological data to target HIV prevention resources; and to ensure that the planning process takes into account scientific information on the effectiveness and efficiency of different HIV interventions. Local community planning groups are charged with identifying and prioritizing unmet HIV prevention needs in their communities, as well as prioritizing prevention interventions designed to address these needs. Their recommendations, in turn, form the basis for the local health department's request for HIV prevention funding from the Centers for Disease Control and Prevention.Given the community planning process's central role in the allocation of federal HIV prevention funds, it is critical that sound decision-making procedures inform this process. In this article, we review the basics of the community planning prioritization process and summarize the decision-making experiences of community planning groups across the US. We then describe several priority-setting tools and decision analytic models that have been developed to assist in HIV community planning prioritization and discuss their strengths and weaknesses. Finally, we offer suggestions for improving the decision-analytic basis for HIV prevention community planning.     

Surveillance methods to monitor the impact of HIV therapy programmes in resource-constrained countries

To monitor the collective national impact of initiatives to expand the availability of HIV therapy including antiretroviral treatment (ART) countries need to monitor the proportion of HIV-infected individuals who are receiving HIV therapy, whether morbidity is decreasing, and HIV-infected individuals are experiencing increased survival, and if there is an overall decrease in the number of individuals dying of HIV. However, in many resource-constrained countries these data are limited or unavailable. Morbidity surveillance relies primarily on AIDS case reporting, but severe under-reporting limits the usefulness of these data. A variety of AIDS case definitions are in use and case definitions do not concur with clinical staging definitions. Harmonizing AIDS case definitions with clinical staging, providing resources and training to improve reporting, and using other surveillance systems, such as tuberculosis programme data to monitor morbidity are urgently needed. A cohort analysis of individuals in ART programmes to follow the progress and outcomes of these patients longitudinally is important to monitor quality of care and impact. Because the rapid scale-up of ART programmes may result in HIV drug resistance, surveillance for drug resistant viruses is also required. Very few resource-constrained countries have well-functioning vital registration systems to assess mortality trends and cause-specific mortality. Alternative approaches to measuring mortality trends, such as sample vital registration with verbal autopsy should be considered. Strong commitments from governments, international organizations and other partners are needed to establish and strengthen the HIV morbidity and mortality monitoring surveillance systems.