Abstract
BackgroundYunnan has the largest number of reported HIV/AIDS cases among all Chinese provinces, the reported prevalence of HIV among Yunnan men who have sex with men (MSM) passed 10%, while HIV incidence epidemic and molecular characteristics of new infected Yunnan MSM were not evaluated before.MethodsAn 18 months prospective followed up with a frequency of 3 month per visit were conducted among HIV seronegative MSM in Kunming cityduring 2009–2011. Interviewer-administrated questionnaires were carried out. Blood specimens were obtained to test for syphilis and HIV, in which HIV were evaluated by standard HIV enzyme immunoassay (EIA) and HIV nucleic acid amplification testing (NAAT). Near full-length regions of the HIV-1 were evaluated for subtyping, primary drug resistance mutations.ResultsDuring the follow-up 70.1% of the recruited 378 MSM retained in the cohort. Eleven MSM seroconverted to HIV and fifteen MSM seroconverted to syphilis. The HIV incidence and syphilis incidence was 3.5 (95% CI 1.8-6.2) cases /100 person year(PY) and 5.3 (95% CI 3.0-8.7) cases/100 PY, respectively. Multivariate analysis showed that baseline syphilis infection (aHR, 17.7), occupation (students vs. others [aHR, 5.7], retirees vs. others [aHR, 4.1]), bleeding experience after receptive anal intercourse (aHR,7.6), and minority ethnic(vs. Han) [aHR, 5.7] were independent risk factors for HIV seroconversion(each P<0.05). Among the 7/11 successfully amplified near full-length sequences, 71.4% (5/7) were CRF01_AE, and 28.6% (2/7) were CRF07_BC. Two HIV transmission pairs were detected among seroconverted minority ethnic MSM.ConclusionsHIV incidence was moderately high among Yunnan MSM. Yunnan province need to strengthen both HIV and syphilis screening among MSM population. Some subpopulations of MSM, such as students, retirees and minority ethnic groups require more HIV epidemic surveillance and strengthened behavior interventions. HIV subtypes and primary drug resistance should be continually monitored to track cross-group transmission of HIV strains.
Highlights
Yunnan has the largest number of reported HIV/AIDS cases among all Chinese provinces, the reported prevalence of HIV among Yunnan men who have sex with men (MSM) passed 10%, while HIV incidence epidemic and molecular characteristics of new infected Yunnan MSM were not evaluated before
The HIV epidemic among MSM population is of particular concern: homosexually transmitted infection cases accounted for 0.3% of the total reported HIV/AIDS cases in 2006, and rapidly increased to 13.0% in 2011 [1]
The first outbreak of HIV epidemic was initially detected among injection drug users (IDUs) in Yunnan province, which borders the drugtrafficking routes known as the "Golden Triangle" [8,9]
Summary
Yunnan has the largest number of reported HIV/AIDS cases among all Chinese provinces, the reported prevalence of HIV among Yunnan men who have sex with men (MSM) passed 10%, while HIV incidence epidemic and molecular characteristics of new infected Yunnan MSM were not evaluated before. In 2008, one large scale cross-sectional study of MSM in 61 cities of China found that the average HIV prevalence had reached 4.9% [2]. Some metropolises such as Beijing [3], Shenyang [4], Harbin [5], Chongqing [6], and Zhengzhou [1]have all seen a rapidly increasing HIV prevalence among their MSM populations. Yunnan has the largest number of reported HIV/AIDS cases among all Chinese provinces It accounted for 22% (93,567/429,000) [1,7] of the total reported HIV/AIDS cases (PLWHs) in China. During 2007–2008, the prevalence of HIV among Kunming MSM reached 10.82% [11]
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