An analysis of HIV-related behaviors and attitudes among college students in eastern China: A cross-sectional study

HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

BackgroundThe dramatic increase in human immunodeficiency virus (HIV) infection among undergraduate students in China, especially among the male students, is alarming. This study aimed to describe sexual attitudes and behaviours and to examine the use of HIV prevention services and related factors among male undergraduate students in Hunan, China.MethodsA cross-sectional survey was conducted from November 2017 to January 2018 among male students from three universities in Hunan, China. Self-administered questionnaires were uploaded online to collect data anonymously. HIV-related knowledge and sexual attitudes were assessed with the unified National AIDS Sentinel Surveillance Questionnaire and Sexual Attitude Scale, whereas sexual behaviours and use of HIV prevention services were examined with researcher-created questionnaires. HIV-related knowledge, sexual attitudes and behaviours, and use of HIV prevention services were described. Chi-square test and logistic regression were used to analyse the factors associated with the use of HIV prevention education services. P values ≤0.05 were considered significant.ResultsOf the 1431 respondents, 1068 (74.6%; 95% CI: 72.4–76.0%) used HIV prevention education services and 105 (7.3%) took HIV testing. The openness of sexual attitudes was moderate overall. About 299 (20.9%) of this sample had active sex partners, and 49 (16.4%) of them had sex with males. The consistent use of condoms was unsatisfactory among the sexually active students, especially among those with homosexual behaviours. Participants who were older in age (OR: 0.77, 95% CI: 0.70–0.86), who were university seniors (OR: 0.80, 95% CI: 0.70–0.91), who drank alcohol (OR: 0.71, 95% CI: 0.55–0.93), and who had open attitude towards paid sex (OR: 0.72, 95% CI: 0.54–0.95), were less likely to use HIV prevention education services.ConclusionsAlthough male undergraduate students show open attitude to premarital sex and engage in risky sexual behaviours, their use of HIV prevention education services is unsatisfactory, particularly in terms of HIV testing. More comprehensive and specific education on HIV prevention and testing services should be designed and offered on campus.

To determine whether human immunodeficiency virus (HIV) counseling and testing has an effect on reducing subsequent risk behaviors in those tested, to evaluate stability in condom use over time, and to determine whether self-reported frequency of condom use relates to the incidence of sexually transmitted diseases (STDs). Cohort study with 2-year follow-up. An urban adolescent-medicine clinic. A random sample of 149 patients (118 female and 31 male adolescents) with a mean (+/- SD) age of 16.4 +/- 1.51 years were selected from a cohort of 500 patients at high risk for HIV infection. The patients had received a risk behavior questionnaire during pretest counseling for HIV testing. They were divided into 3 groups, identified by the letter F, S, or R, based on their self-report of frequency of condom use at enrollment: 24% used condoms frequently/always (F); 40%, sometimes (S); and 36%, rarely/never (R). One hundred twenty-six patients (85%) made return visits. HIV counseling and testing. Medical record documentation of STDs before and after HIV testing, and self-reported condom use frequency. Before HIV testing, all 3 condom use groups had a similar frequency of STD visits per month. The number of STD visits per month did not decrease significantly in the posttest period for either the total group or each of the 3 subgroups. Also, most patients (F, 67%; S, 44%; R, 53%) in each of the 3 subgroups had shifted unfavorably to rarely/never (R) condom use within the month before their follow-up visit. Only 24% (8 patients) of those in the initial frequently/always (F) group reported continued frequent condom use. As has been found in adult studies, single-dose interventions such as HIV counseling and testing did not seem to reduce HIV risk behaviors in our sample of high-risk adolescent patients. None of the 3 groups showed a significant decrease in STDs after HIV testing and counseling. Also, our adolescent patients reported widely varying condom use frequency over time, yet the incidence of STDs did not correlate with self-reported condom use.

To assess sexually active adolescents' knowledge, attitudes, and behaviors associated with human immunodeficiency virus (HIV) testing and to determine the factors important in their decision to obtain voluntary HIV testing. Anonymous, random, digit-dial telephone survey undertaken in 1993. Massachusetts households. Adolescents, 16 to 19 years of age. Of the 567 adolescents surveyed who had sexual intercourse within the past year, 127 (22%) had received HIV testing, with 54 (10%) stating that this testing was for personal reasons. A "great deal" or "some" worry about getting HIV/acquired immunodeficiency syndrome (AIDS) was expressed by 51%, and 56% felt that it was at least a little likely that they will get AIDS. Misconceptions were common about aspects of HIV testing: 35% did not believe or did not know that the HIV test results were kept in confidence, 19% thought that AIDS testers informed partners if the results were positive, and 30% did not think that the HIV test was very accurate. Although 92% (452/490) had seen a physician in the past year, only 30% (136/452) had ever discussed AIDS with a doctor. Multivariable analysis identified five factors as independently associated with voluntary adolescent HIV testing: 1) having had more than one sexual partner within the past year [odds ratio (OR): 2.9; 95% confidence interval (CI): 1.5, 5.5]; 2) believing that condoms are only somewhat effective at preventing the spread of AIDS (OR: 2. 6; 95% CI: 1.4, 4.8); 3) having discussed AIDS with a doctor (OR: 2. 6; 95% CI: 1.4, 4.8); 4) not having had a teacher discuss AIDS (OR: 2.2; 95% CI: 1.2, 4.2); and 5) believing that a positive test result means one has AIDS as opposed to carrying the virus (OR: 2.0; 95% CI: 1.1, 3.7). High-risk behavior of infrequent condom use and a history of a sexually transmitted disease were not significantly associated with voluntary HIV testing. Among sexually active Massachusetts adolescents, voluntary HIV testing is uncommon. Teens who have had multiple sexual partners and who do not believe condoms are effective in preventing transmission were most likely to have been tested. Issues requiring clearer communication to patients include the testing process, its availability, and confidentiality. Physicians can play an influential role in the promotion of HIV testing by discussing HIV risk behaviors with patients and offering those at risk voluntary HIV counseling and testing.

Mississippi has the 10th highest rate of new human immunodeficiency virus (HIV) infections in the United States. The Mississippi State Department of Health (MSDH) integrated partner HIV testing into syphilis partner services (PS) in 2014, but the effectiveness of this as an HIV case finding strategy has not been evaluated. We identified all early syphilis (primary, secondary, and early latent) case records reported from July 1, 2014, to December 31, 2016, excluding case records for people concurrently newly diagnosed with HIV. Among sex partners of these people, we identified new diagnoses of early syphilis and HIV. We calculated the number needed to interview as the number of syphilis index case patients interviewed divided by the number of partners newly diagnosed with early syphilis or HIV. A total of 1535 (95%) of the 1619 early syphilis index case patients were interviewed for PS. These case patients named 2267 partners, of whom 1868 (82%) were contacted by MSDH. Among partners, 1508 (81%) tested for syphilis and 745 (56%) of 1321 partners not previously diagnosed with HIV were tested for HIV. Partner services identified 696 new early syphilis case patients (46%) and 24 (3.2%) new HIV case patients among partners. Sixty-four index case patient interviews were needed to identify 1 new case of HIV, and 2 interviews were needed to identify 1 new case of syphilis among partners. Syphilis PS allowed MSDH to interact with 1592 men who have sex with men over a 30-month period and was effective for identifying people newly infected with early syphilis and HIV. Increasing HIV testing among partners of syphilis case patients could increase HIV case finding in Mississippi.

BackgroundDespite the availability of rapid point-of-care human immunodeficiency virus (HIV) testing, the use of a self-reported HIV status has its own value, especially in research studies. Sexually active people without...

Objective This study aimed to estimate the prevalence of human immunodeficiency virus (HIV) testing, identify factors associated with HIV testing among male students who have engaged in sexual behaviour in Zhejiang province, and provide a scientific basis for the prevention and control of HIV infection on campus. Methods Stratified cluster random sampling analysis was performed, which included general characteristics, sexual attitudes, sexual behaviours, information on HIV testing, and self-risk assessment for HIV infection. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors. Results Among 2734 male students who have engaged in sexual behaviour, 319 (11.7%) had undergone HIV antibody testing in the previous year. The results of multivariate analysis demonstrated that the participants who were in the junior grade level (adjusted odds ratio (AOR) = 1.59, 95% confidence interval (95% CI): 1.10–2.30) exhibited acceptance to male homosexual behaviour (AOR = 1.73, 95% CI: 1.19–2.52), had been exposed to testing publicity in the previous year (AOR = 1.51, 95% CI: 1.06–2.15), had been exposed to self-risk assessment for HIV infection (AOR = 2.66, 95% CI: 1.99–3.55), had male or bisexual partners (AOR = 1.60, 95% CI: 1.05–2.46), had a score for the scale indicating awareness of different testing methods between 2 and 5 (AOR = 2.19, 95% CI: 1.51–3.16) or greater than 6 (AOR = 1.49, 95% CI: 1.01–2.66), and had a score for the scale indicating knowledge of different testing facilities between 3 and 5 (AOR = 1.63, 95% CI: 1.00–2.66) were inclined to engage in HIV testing. Conclusions In this study, the proportion of HIV-testing among male students who have engaged in sexual behaviour was low. This study revealed that students who exhibited acceptance to male homosexual behaviours had been exposed to publicity for HIV testing or a self-risk assessment for HIV infection which were more inclined to engage in HIV testing. Our study underscores the urgent need to enhance educational interventions concerning HIV risks and warnings as part of the health education curriculum on campus. The graveness of the AIDS epidemic among students necessitates this emphasis. Moreover, we recommend deploying condom-dispensing machines or HIV testing facilities across the campus for easy access to preventive and testing services for HIV.

Introduction: According to 2011 Ethiopian demographic health survey result, about 2.2% mothers were HIV (Human Immunodeficiency Virus) positive in Amhara regional state. HIV testing during pregnancy is the gateway for PMTCT (Prevention of Mother to Child Transmission) of HIV though its coverage was 72.0% to 82.5% in North-West Ethiopia. Objective: To assess VHCT (Voluntary HIV Counseling and Testing) service utilization and its determinants among pregnant mothers in North-West Ethiopia in 2014. Methods: A community based cross sectional study using both quantitative and qualitative research methods was conducted in Enemay woreda/district. Data was collected on systematically selected 386 pregnant mothers and 4 FGDs (Focus Group Discussion) on purposively selected pregnant mothers and their partners. A pre tested closed ended structured questionnaire and open ended questions were used to collect the quantitative and qualitative data respectively. Binary logistic regression was used for multivariate analysis of quantitative data. Result: Majority (81.6%) of participants were known transmission of HIV during pregnancy and about three quarter (76.2%) of them were tested for HIV in current pregnancy. In FGD, all participants were not agreed as HIV testing was important during pregnancy. The repeatedly cited reason for not up taking HIV testing during pregnancy was fear of stigma and discrimination if test result becomes positive. Pregnant mothers not knowledgeable about MTCT (Mother to Child Transmission) of HIV; have not intension for ARV Prophylaxisis, unable to bring their partner for test and mothers who believe VHCT was importance before marriage only were less likely utilizing VHCT service thus organizations working on VHCT should further enhance awareness creation by giving especial attention for these groups of pregnant mothers.

Consistent condom use with casual partners is critical for preventing the transmission of human immunodeficiency virus (HIV) among male university students. This study aimed to determine the level of consistent condom use and explore the correlates of condom use consistency in male university students in eastern China. A descriptive cross-sectional survey was conducted in 13 universities in Zhejiang Province, which involved the recruitment of 31,674 students by stratified random sampling. Among them, 545 male students who engaged in casual sex in the year prior to this study were included. Adjusted and unadjusted logistic regression models were used to examine the correlates associated with consistent condom use. Among the 545 male university students, only 205 (37.6%) consistently used condoms in the previous year. The following correlates were associated with higher rates of consistent condom use: 1) Knowledge, specifically, the number of correct answers to "HIV infection can be determined by appearance" (AOR: 2.06, 95% CI: 1.21-3.49); 2) never finding casual partners on the internet during the past over the prior year (AOR: 0.63; 95% CI: 0.40-0.99); 3) never drinking alcohol before casual sex during the last over the prior year (AOR: 0.30; 95% CI: 0.20-0.46); 4) never engaging in commercial sex (AOR: 0.57; 95% CI: 0.34-0.96); and 5) high condom self-efficacy score (AOR: 2.55; 95% CI: 1.44-4.49). The study found a low level of consistent condom use among male university students. Promoting condom self-efficacy, reducing web-based casual sex, drinking before sex, and commercial sex are essential to improving the level of consistent condom use among male university students to reduce the transmission of HIV.

To understand the human immunodeficiency virus (HIV) infection status and syphilis prevalence among men who have sex with men (MSM) receiving voluntary counseling and testing appointed through a web-based registering system and related factors. The MSM receiving web appointed HIV counseling and testing from 2011 to 2012 in Guangzhou were recruited and a questionnaire survey was conduct among them to obtain the information about their demographic characteristics and sexual behavior. Binary and multivariate logistic regression model were used to identify the factors associated with HIV infection or syphilis prevalence. A total of 4,904 MSM were enrolled in the study, the average age of the MSM was (28.77±7.24) years, and 70.3% of them had high education level; the unmarried MSM accounted for 72.7%. The HIV infection rate and syphilis prevalence were 8.7% and 4.4% respectively. The co-infection rate of HIV and Treponema pallidum was 1.2% (59/4 904). About one in three MSM did not use condom at latest homosexual behavior, 43.5% did not use condoms at each homosexual behavior in the past three months. Lower education level, occupation (worker or farmer), non-consistent condom use at each sex with men in the past three months, receiving HIV test or not and Treponema pallidum infection were associated with HIV infection. Age≥40 years, lower education level, multi male sex partners in the past three months and HIV infection were associated with Treponema pallidum infection. MSM receiving web appointed HIV counseling and testing had high prevalence of risk behaviors and high HIV infection rate, but had low previous HIV testing rate. It is necessary to strengthen the promotion of HIV test through web based appointment and conduct target behavior intervention in older MSM with lower education level.

We evaluated the impact of human immunodeficiency virus (HIV) testing and counseling on self-reported condom and spermicide use and on corresponding HIV seroconversion and gonorrhea rates in urban Rwandan women. Prospective cohort study with 2 years of follow-up, comparison of outcome variables before and after an intervention, and condom use measured in a control group that did not receive the intervention. Outpatient research clinic in Kigali, the capital of Rwanda. One thousand four hundred fifty-eight childbearing women, 32% of whom were infected with HIV, were enrolled in a prospective study in 1988, and followed at 3- to 6-month intervals for 2 years. Follow-up was available for 95% of subjects at year 1 and 92% at year 2. An acquired immunodeficiency syndrome (AIDS) educational videotape, HIV testing and counseling, and free condoms and spermicide were provided to all participants and interested sexual partners. Self-report of compliance with condom-spermicide use and observed incidence of HIV and gonorrhea. Only 7% of women reported ever trying condoms before the intervention, but 22% reported condom use with good compliance 1 year later. Women who were HIV-positive were more likely to adopt condom use than HIV-negative women (36% vs 16%; P < .05). Independent predictors of condom use, both in HIV-positive and in HIV-negative women, included HIV testing and counseling of the male partner, having a nonmonogamous relationship, and believing condoms were not dangerous. Human immunodeficiency virus seroconversion rates decreased significantly (from 4.1 to 1.8 per 100 person-years; P < .04) in women whose partners were tested and counseled. The prevalence of gonorrhea decreased substantially (13% to 6%; P < .05) among HIV-positive women, with the greatest reduction among condom users (16% to 4%; P < .05). A confidential HIV testing and counseling program was associated with increased use of condoms and reduced rates of gonorrhea and HIV in urban Rwandan women. The lack of risk reduction in HIV-negative women whose partner's serostatus was unknown was of concern. Interventions that promote HIV testing and counseling for both members of a couple should be considered in other high-prevalence areas.

The HIV Epidemic Among Women in the United States: A Persistent Puzzle

<h3>Objective.</h3> —We evaluated the impact of human immunodeficiency virus (HIV) testing and counseling on self-reported condom and spermicide use and on corresponding HIV seroconversion and gonorrhea rates in urban Rwandan women. <h3>Design.</h3> —Prospective cohort study with 2 years of follow-up, comparison of outcome variables before and after an intervention, and condom use measured in a control group that did not receive the intervention. <h3>Setting.</h3> —Outpatient research clinic in Kigali, the capital of Rwanda. <h3>Participants.</h3> —One thousand four hundred fifty-eight childbearing women, 32% of whom were infected with HIV, were enrolled in a prospective study in 1988, and followed at 3- to 6-month intervals for 2 years. Follow-up was available for 95% of subjects at year 1 and 92% at year 2. <h3>Interventions.</h3> —An acquired immunodeficiency syndrome (AIDS) educational videotape, HIV testing and counseling, and free condoms and spermicide were provided to all participants and interested sexual partners. <h3>Main Outcome Measures.</h3> —Self-report of compliance with condom-spermicide use and observed incidence of HIV and gonorrhea. <h3>Results.</h3> —Only 7% of the women reported ever trying condoms before the intervention, but 22% reported condom use with good compliance 1 year later. Women who were HIV-positive were more likely to adopt condom use than HIV-negative women (36% vs 16%;<i>P</i>&lt;.05). Independent predictors of condom use, both in HIV-positive and in HIV-negative women, included HIV testing and counseling of the male partner, having a nonmonogamous relationship, and believing condoms were not dangerous. Human immunodeficiency virus seroconversion rates decreased significantly (from 4.1 to 1.8 per 100 person-years;<i>P</i>&lt;.04) in women whose partners were tested and counseled. The prevalence of gonorrhea decreased substantially (13% to 6%;<i>P</i>&lt;.05) among HIV-positive women, with the greatest reduction among condom users (16% to 4%;<i>P</i>&lt;.05). <h3>Conclusion.</h3> —A confidential HIV testing and counseling program was associated with increased use of condoms and reduced rates of gonorrhea and HIV in urban Rwandan women. The lack of risk reduction in HIV-negative women whose partner's serostatus was unknown was of concern. Interventions that promote HIV testing and counseling for both members of a couple should be considered in other high-prevalence areas. (<i>JAMA</i>. 1992;268:3338-3343)

Evidence showing the individual and public health benefits of antiretroviral therapy (ART) has galvanised global efforts to increase the number of people receiving ART, particularly in low- and middle-income countries. Significant treatment gains have undoubtedly been made, particularly in sub-Saharan Africa, with recent reports showing that approximately 9.7 million people were receiving ART in 2012, approximately 65 per cent of the 15 million people targeted to access ART by end of 2015.1 Marked disparities in access to ART persist, however, with treatment gains not reaching enough children, adolescents and key affected populations (KAP), including sex workers, people who inject drugs (PWID), men who have sex with men and transgender people. Human immunodeficiency virus (HIV) testing represents the first step of an HIV treatment cascade that needs to be followed by receipt of test results, linkage and retention in care, initiation of HIV therapy and, ultimately, viral load suppression.2 The challenges in maintaining this cascade are particularly burdensome in low- and middle-income countries and in treatment programmes focusing on KAP. In this issue of Public Health Action, Denisiuk and colleagues describe the low rate of HIV testing in more than 190 000 people at high risk of HIV infection attending HIV prevention programmes implemented by local and international non-governmental organisations in Ukraine.3 Opportunities to increase the rate of HIV testing amongst those who initially test negative in these treatment programmes were also lost, with no more than three in 10 undergoing retesting within a year of the initial test. Different models of care, ranging from dedicated centres for KAP to integrating HIV testing into methadone treatment centres, have been implemented to improve HIV prevention and treatment amongst KAP.4,5 In a large study involving 13 methadone treatment centres in Yunnan Province, China, 33% of 1935 individuals attending the centres were diagnosed with HIV on enrolment. Biannual HIV testing amongst those who attended the programme diagnosed 13 new episodes of seroconversion amongst the participants. The rate of loss to follow-up in these treatment centres was unfortunately high, representing another lost opportunity to improve HIV testing and counselling.5 Suboptimal HIV testing has been reported across all risk groups. In addition to difficulties in gaining access to HIV testing centres, fear as a consequence of criminalisation of drug use, sex work and homosexuality represents barriers to HIV testing among KAP in several countries. Furthermore, stigma and discrimination, fear of knowing their HIV status and lack of knowledge about the benefits of treatment further prevent these individuals from undergoing HIV testing. Potential interventions to improve coverage of HIV testing, particularly for these marginalised communities, include expansion of home-based testing and self-testing as well as community engagement to destigmatise HIV. Similar challenges exist in ensuring linkage to care, initiation of therapy and long-term adherence to treatment to ensure viral suppression, particularly amongst KAP. Considerable effort and investment at all levels, for example by increasing the availability of point-of-care testing and laboratory monitoring, an expanded, well trained health care workforce as well as the use of technology to assist with adherence and programme monitoring, are needed to ensure not only that the global goals of treatment are met but also that long-term adherence to treatment is assured across all infected populations.2

Population-based estimates of human immunodeficiency virus (HIV) prevalence and risk behaviors among men who have sex with men (MSM) are valuable for HIV prevention planning but not widely available, especially at the local level. We combined two population-based data sources to estimate prevalence of diagnosed HIV infection, HIV-associated risk-behaviors, and HIV testing patterns among sexually active MSM in New York City (NYC). HIV/AIDS surveillance data were used to determine the number of living males reporting a history of sex with men who had been diagnosed in NYC with HIV infection through 2002 (23% of HIV-infected males did not have HIV transmission risk information available). Sexual behavior data from a cross-sectional telephone survey were used to estimate the number of sexually active MSM in NYC in 2002. Prevalence of diagnosed HIV infection was estimated using the ratio of HIV-infected MSM to sexually active MSM. The estimated base prevalence of diagnosed HIV infection was 8.4% overall (95% confidence interval [CI] = 7.5-9.6). Diagnosed HIV prevalence was highest among MSM who were non-Hispanic black (12.6%, 95% CI = 9.8-17.6), aged 35-44 (12.6%, 95% CI = 10.4-15.9), or 45-54 years (13.1%, 95% CI = 10.2-18.3), and residents of Manhattan (17.7%, 95% CI = 14.5-22.8). Overall, 37% (95% CI = 32-43%) of MSM reported using a condom at last sex, and 34% (95% CI = 28-39%) reported being tested for HIV in the past year. Estimates derived through sensitivity analyses (assigning a range of HIV-infected males with no reported risk information as MSM) yielded higher diagnosed HIV prevalence estimates (11.0-13.2%). Accounting for additional undiagnosed HIV-infected MSM yielded even higher prevalence estimates. The high prevalence of diagnosed HIV among sexually active MSM in NYC is likely due to a combination of high incidence over the course of the epidemic and prolonged survival in the era of highly active antiretroviral therapy. Despite high HIV prevalence in this population, condom use and HIV testing are low. Combining complementary population-based data sources can provide critical HIV-related information to guide prevention efforts. Individual counseling and education interventions should focus on increasing condom use and encouraging safer sex practices among all sexually active MSM, particularly those groups with low levels of condom use and multiple sex partners.