Abstract
Dearth of information regarding the trend and correlates of HIV, syphilis and Hepatitis C (HCV) in a country-wide sample of understudied though high-risk Chinese men who have sex with men (MSM) called for a comprehensive serial cross-sectional study. Using a multistage mixed-method strategy, 171,311 MSM from 107 selected cities/counties in 30 provinces of mainland China, were interviewed and tested. Descriptive, bivariate, multivariate and Cochran-Armitage trend analyses were conducted using SAS 9.2. During 2009-13, recent (71.5% to 78.6%, p < 0.001) and consistent (40.4% to 48.8%, p < 0.001) condom use as well as condom use during commercial anal sex (46.5% to 55.0%, p < 0.001) were increasing. In contrast, commercial anal sex with male (11.9% to 7.1%, p < 0.001) and drug use (1.9% to 0.8%, p < 0.001) were decreasing over time. HIV prevalence increased gradually (5.5% to 7.3%, p < 0.001), while syphilis (9.0% to 6.3%, p < 0.001) and HCV prevalence (1.5% to 0.7%, p < 0.001) decreased over time. A positive correlation was observed between HIV and syphilis prevalence (r = 0.38). HIV infection was associated with HIV-related knowledge, services and injecting drug use. An increasing trend of HIV prevalence was observed during 2009–13 among MSM in China. While gradual reduction of risk behaviors along with syphilis and HCV prevalence supported expansion of testing and prevention services, increasing HIV burden called for deeper thematic investigations.
Highlights
Established socio-demographic, environmental, behavioral and policy related contextual risk factors for HIV were all found to be largely inter-related
Few national level studies had ever focused on the trends of these diseases[13,26]. This is the second paper[27], in our research series that focused on the trend of HIV, syphilis and HCV prevalence among high risk populations in China where we investigated the trends of prevalence of these diseases, relevant behavioral trends and geologic distribution along with their correlations among men who have sex with men (MSM) in this country
Given the poor HIV related awareness among people living with HIV/AIDS7 and the persistently high unprotected anal intercourse among MSM in China[31], there was a high likelihood of alarming upsurge of the epidemic within this high-risk population
Summary
Established socio-demographic, environmental, behavioral and policy related contextual risk factors for HIV were all found to be largely inter-related. Having a deeper understanding of the interplay between such risk factors appeared to be mandatory for further reduction in spread of HIV from and within the Chinese MSM population. There was a pressing need for additional research on changes in the dynamics of HIV and STI epidemics and risk behaviors for providing adequate insight regarding need assessment, program planning, and comprehensive policy response. Studies investigating such trends in prevalence of HIV, other STIs (including syphilis and HCV) and risk behaviors among Chinese MSM were limited. A serial cross-sectional study was called for to determine the trends of the aforementioned parameters and their interplay involving a multistage sample of MSM that could ensure somewhat national-level representativeness (as much as possible)
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