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Factors associated with unprotected anal intercourse among male students who have sex with men in three Northern regions of China

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Chinese Medical Journal 2019年第14期132卷 1639-1644页

作者： De-Chuan Zhang Zun-You Wu Sarah Robbins Scott Department of Epidemiology and Biostatistics School of Public HealthAnhui Medical UniversityHefeiAnhui 230032China National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and PreventionBeijing 102206China

Background:Unprotected anal intercourse (UAI) has previously been associated with human immunodeficiency virus (HIV) infection.Male students who have sex with men (SMSM) are at increased exposure to experience UAI.The aim of this study was to investigate the status of UAI and related factors among SMSM in three northern regions of China.Methods:From November 2018 to January 2019,SMSM,18 years or older,studying or living in Beijing,Tianjin,or Shijiazhuang,who had anal sex in the past 6 months were recruited by community-based organizations to participate in an unmatched,casecontrol study.Detailed demographic and behavioral information were collected via self-administrated electronic questionnaires and factors related to UAI were assessed using uni-and multivariate logistic regression analyses.Results:Among the 511 SMSM included in the study,210 (41.1%) reported UAI in the past 6 months.SMSM who had sexual partners at least 10 years older than themselves (odds ratio [OR]=2.277,95% confidence interval [CI]:1.380-3.756),used vacant capsules before sexual activity (OR =3.858,95 % CI:1.472-10.106),had a self-perceived moderate-HIV risk (OR =2.128,95 %CI:1.403-3.227),and unprotected,first anal intercourse (OR =2.236,95 % CI:1.506-3.320) had increased odds of UAI.Contusions:Factors associated with increased odds of engaging in UAI in the past 6 months among SMSM included having older sexual partners,using vacant capsules,having a self-perceived moderate risk of HIV,and unprotected,first anal intercourse.Continuing education on risk reduction,including improving condom decision making in age-discordant relationships could help address the sexual risk behaviors among SMSM.

关键词： Students Men who have sex with men Unsafe Sex China

Human immunodeficiency virus/acquired immunodeficiency syndrome prevalence,incidence,and mortality in China,1990 to 2017:a secondary analysis of the Global Burden of Disease Study 2017 data

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Chinese Medical Journal 2021年第10期134卷 1175-1180页

作者： Xue-Jiao Liu Jennifer M.McGoogan Zun-You Wu National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and PreventionBeijing 102206China Fielding School of Public Health University of CaliforniaLos AngelesCAUSA

Background:Despite almost two decades of well-funded and comprehensive response efforts by the Chinese Government,human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)remains a major problem in China.Yet,few studies have recently examined long-term trends in HIV/AIDS prevalence,incidence,and mortality at the national level.This study aimed to determine the prevalence,incidence,and mortality trends for HIV/AIDS over the past 28 years in China.Methods:We conducted a descriptive,epidemiological,secondary analysis of the Global Burden of Diseases,Injuries,and Risk Factors Study 2017 data.To evaluate trends in prevalence,incidence,and mortality over the study period from 1990 to 2017,we calculated values for annual percentage change(APC)and corresponding 95%confidence intervals(CIs)using joinpoint regression analysis.Results:A significant increase in HIV/AIDS prevalence was observed for 1990 to 2009(APC:10.7;95%CI:10.4,11.0;P<0.001),and then remained stable for 2009 to 2017(APC:0.7;95%CI:-0.3,1.7;P=0.1).A significant increase in HIV incidence was also observed for 1990 to 2005(APC:13.0;95%CI:12.6,13.4;P<0.001),and then a significant decrease was detected for 2005 to 2017(APC:-6.5;95%CI:-7.0,-6.1;P<0.001).A significant increase in AIDS-related mortality rate was detected for 1990 to 2004(APC:10.3;95%CI:9.3,11.3;P<0.001),followed by a period of stability for 2004 to 2013(APC:1.3;95%CI:-0.7,3.3;P=0.2),and then another significant increase for 2013 to 2017(APC:15.3;95%CI:8.7,22.2;P<0.001).Conclusions:Although prevalence has stabilized and incidence has declined,AIDS-related mortality has risen sharply in recent years.These findings suggest more must be done to bring people into treatment earlier,retain them in treatment more effectively,actively seek to reenter them in treatment if they dropout,and improve the quality of treatment and care regimens.

关键词： Prevalence Incidence Mortality HIV Trend China Acquired immunodeficiency syndrome

HIV care continuum among newly diagnosed student and non-student youths between 2012 and 2016 in Hangzhou, China

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Chinese Medical Journal 2019年第12期132卷 1420-1428页

作者： Yan Luo Hong wu Xing-Liang Zhang Xi-Ting Li Sarah Robbins Scott Jun-Fang Chen Zun-You Wu Hangzhou Center for Disease Control and Prevention HangzhouZhejiang 310021China National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and PreventionBeijing 102206China

Background: youths are disproportionally affected by the human immunodeficiency virus (HIV) infection. We aimed to assess antiretroviral therapy (ART) initiation and viral suppression rates among student and non-student youths in Hangzhou, China. Methods: Data were taken from the Chinese HIV/acquired immune deficiency syndrome Comprehensive Response Information Management System. youths aged 15 to 24 years who were newly diagnosed with HIV between 2012 and 2016 and were living in Hangzhou were included in the study. Comparisons between student and non-student youths were made for ART initiation within 30 days, 90 days, and 12 months of HIV diagnosis, and the viral suppression rate at 12 months of HIV diagnosis and at 12 months of ART initiation. Results: A total of 707 cases met inclusion criteria, 29.6% of which were students and 70.4% were non-student youths. The student group had a higher proportion of ART initiation compared with the non-student group within 30 days of diagnosis (45.5% vs. 37.0%, P = 0.044), and a slightly higher but not statistically significant proportion at 90 days (67.0% vs. 62.7%), and 12 months (83.7% vs. 78.5%) of HIV diagnosis. ART initiation within 30 days improved from 90% in 2016. A smaller proportion of students experienced viral suppression compared with the non-student group (9.6% vs. 17.1%, P = 0.011) at 12 months after HIV diagnosis, but the suppression rate was similar at 12 months of ART initiation (69.9% vs. 71.1%, P = 0.743). Conclusions: ART initiation in both student and non-student youths has significantly improved between 2012 and 2016. However, the viral suppression rate remained unacceptably low at 12 months of HIV diagnosis in both student and non-student groups. Specific intervention strategies must be taken to address this challenge.

关键词： Human immunodeficiency virus Antiretroviral therapy Viral suppression Student Non-student youths

COVID-19 seeding time and doubling time model:an early epidemic risk assessment tool

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Infectious Diseases of Poverty 2020年第3期9卷 3-11页

作者： Lei Zhou Jiang-Mei Liu Xiao-Ping Dong Jennifer M.McGoogan Zun-You Wu Public Health Emergency Center Chinese Center for Disease Control and Prevention155 Changbai RoadChangping DistrictBeijing 102206China National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention155 Changbai RoadChangping DistrictBeijing 102206China Global Health Center Chinese Center for Disease Control and Prevention155 Changbai RoadChangping DistrictBeijing 102206China National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention155 Changbai RoadChangping DistrictBeijing 102206China

Background:As COVID-19 makes its way around the globe,each nation must decide when and how to respond.Yet many knowledge gaps persist,and many countries lack the capacity to develop complex models to assess risk and response.This paper aimed to meet this need by developing a model that uses case reporting data as input and provides a four-tiered risk assessment output.Methods:We used publicly available,country/territory level case reporting data to determine median seeding number,mean seeding time(ST),and several measures of mean doubling time(DT)for COVID-19.We then structured our model as a coordinate plane with ST on the x-axis,DT on the y-axis,and mean ST and mean DT dividing the plane into four quadrants,each assigned a risk level.Sensitivity analysis was performed and countries/territories early in their outbreaks were assessed for risk.Results:Our main finding was that among 45 countries/territories evaluated,87%were at high risk for their outbreaks entering a rapid growth phase epidemic.We furthermore found that the model was sensitive to changes in DT,and that these changes were consistent with what is officially known of cases reported and control strategies implemented in those countries.Conclusions:Our main finding is that the ST/DT Model can be used to produce meaningful assessments of the risk of escalation in country/territory-level COVID-19 epidemics using only case reporting data.Our model can help support timely,decisive action at the national level as leaders and other decision makers face of the serious public health threat that is COVID-19.

关键词： Seeding time Doubling time Case report Risk assessment SARS-CoV-2 COVID-19

Duration of Human Immunodeficiency Virus Infection at Diagnosis among New Human Immunodeficiency Virus Cases in Dehong, Yunnan, China, 2008-2015

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Chinese Medical Journal 2018年第16期131卷 1936-1943页

作者： Ai-Hua Li Zun-You Wu Zhen Jiang Jennifer M. McGoogan Yan Zhao Song Duan National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention Beijing 102206 China Department of Epidemiology University of California Los Angeles California USA Dehong Prefecture Center for Disease Control and Prevention Mangshi Yunnan 678400 China

Background： On diagnosis of human immunodeficiency virus （HIV） infection, a person may have been infected already for many years. This study aimed to estimate the duration of HIV infection at the time of diagnosis. Methods： Newly diagnosed HIV cases in Dehong, China, from 2008 to 2015 were studied. Duration of infection at the time of diagnosis was calculated using the first CD4 cell count result after diagnosis and a CD4 depletion model of disease progression. Multiple linear regression analysis was used to investigate the associated risk factors. Results： A total of 5867 new HIV cases were enrolled. Overall, mean duration of infection was 6.3 years （95% confidence interval [CI]： 6.2, 6.5）. After adjusting for confounding, significantly shorter durations of infection were observed among participants who were female （beta： -0.37, 95% CI： -0.64, -0.09）, Dai ethnicity （beta： -0.28, 95% CI： -0.57, 0.01 ）, and infected through injecting drug use （beta： -1.82, 95% CI： -2.25, -1.39）. Compared to the hospital setting, durations were shorter for those diagnosed in any other settings, and compared to 2008, durations were shorter for those diagnosed all years after 2010. Conclusion： Although the reduction in duration of infection at the time of diagnosis observed in Dehong was significant, it may not have had a meaningful impact.

关键词： China Delayed Diagnosis Human lmmunodeficiency Virus Infection

Impact of HIV/sexually transmitted infection testing on risky sexual behaviors among men who have sex with men in Langfang, China

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Chinese Medical Journal 2013年第7期126卷 1257-1263页

作者： GUO Wei wu zun-you SONG Ai-jun National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention Beijing 102206 China Division of AIDS/STD Control and prevention Diseases Control and Prevention in Langfang Langfang Hebei 065000 China

Background Men who have sex with men （MSM） in China remain at high risk for HIV infection, the proportion of reported HIV/AIDS cases that occurred among MSM rose greatly from 2005 to 2011. HIV testing and counseling is a critical HIV prevention strategy among HIV related high-risk population, including MSM in China. This article aimed to assess the association between receiving HIV testing and high-risk sexual behaviors among MSM in Langfang, Hebei Province, China. Methods Between September and November 2007, 233 MSM were recruited to receive an HIV testing intervention. Face-to-face interviews were conducted before HIV testing and 3 months later HIV-related risk behaviors were assessed. Serological testing for HIV and other sexually transmitted infections （STIs） was performed. Results Of the recruited 233 MSM, 200 completed follow-up. Baseline prevalence was 7.8% for HIV, 21.0% for syphilis, 15.8% for gonorrhea, and 5.0% for chlamydia. Multivariate analysis indicated that inconsistent condom use （OR=7.9, 95% CI： 0.9-66.7, P=0.059） and bleeding during anal sex （OR=5.9, 95% Cl： 1.3-26.2, P=0.019） were risk factors for HIV infection, and group sex （OR=6.6, 95% Cl： 2.2-19.7, P=0.001） was a risk factor for syphilis infection at baseline. At 3 months follow-up, among STI-positive MSM, self-reported anal sex fell from 73.1% to 38.5% （P 〈0.001）; group sex fell from 19.2% to 5.8% （P 〈0.001）; and bleeding during anal sex fell from 23.1% to 5.8% （P 〈0.001）. Among STI-negative MSM, the frequency of one-night stands fell from 32.5% to 17.2% （P 〈0.001）, and oral sex rose from 57% to 78.5% （P 〈0.001）. STI-positive MSM were less likely to engage in anal sex compared to STI-negative MSM （X^2=5.189, P=0.023）. Conclusions HIV testing is an important intervention strategy among MSM. HIV testing services among MSM need to be scaled up, along with comprehensive, tailored interventions including condom promotion and STI treatment.

关键词： men who have sex with men sexually transmitted infections HIV testing and counseling sexual behavior

An overview of the history of epidemic of and response to HIV/AIDS in China： achievements and challenges

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Chinese Medical Journal 2009年第19期122卷 2251-2257页

作者： CUI Yan Adrian Liau wu zun-you National Centre for AIDS/STD Control and Prevention Chinese Centre for Disease Control and Prevention Beijing 100050 China

Since the first case of acquired immunodeficiency syndrome （AIDS） in China was identified and reported in 1985, the country has experienced dramatic changes in the course of its human immunodeficiency virus （HIV）/AIDS epidemic along1 with the government＇s response to it in the past 24 years. As the severity of the epidemic grew, so too has the government＇s reaction to it.

关键词： China HIV/AIDS achievements challenges

Asymptomatic and Pre-Symptomatic COVID-19 in China

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Infectious Diseases of Poverty 2020年第3期9卷 1-2页

作者： zunyou wu Jennifer M.McGoogan National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention155 Changbai RoadChangping DistrictBeijing 102206China

As the novel coronavirus disease 2019(COVID-19)pandemic spreads rapidly across the globe many unanswered questions about the basic biology and epidemiology of the disease hamper our response strategies and limit our ability to achieve control and prevent a rebound or so-called“second wave”.One such crucial question is:To what degree do asymptomatic cases contribute to transmission?Early,small studies on this subject have found wide ranging estimates of the prevalence of asymptomatic carriers,and just a handful of studies so far have documented viral shedding by asymptomatic cases[1].We recently re-examined China’s COVID-19 case report data to investigate this question[2].This Editorial aims to describe how asymptomatic cases contribute to transmission and what the implications are for control strategies.

关键词： Novel coronavirus disease 2019 Asymptomatic Pre-symptomatic Transmission

A community-based comprehensive intervention to reduce syphilis infection—among low-fee female sex workers in China:a matched-pair,community-based randomized study

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Infectious Diseases of Poverty 2019年第6期8卷 51-60页

作者： Wei Dong Chu Zhou Ke-Ming Rou Zun-You Wu Jun Chen Sarah Robbins Scott Man-Hong Jia Yue-Jiao Zhou Xi Chen Division of HIV Prevention National Center for AIDS/STD Control and PreventionChinese Center for Disease Control and Prevention155 Changbai RoadBeijing 102206China Department of Epidemiology UCLA Fielding School of Public HealthLos AngelesUSA Institute of AIDS/STD Control and Prevention Yunnan Provincial Center for Disease Control and PreventionKunmingChina Institute of AIDS Control and Prevention Guangxi Zhuang Autonom ous Region for Disease Control and PreventionNanningChina Division of AIDS/STD Control and Prevention Hunan Provincial Center for Disease Control and PreventionChangshaChina

Background:Low-fee female sex workers(FSWs)are at high risk of acquiring and spreading human immunodeficiency virus(HIV)/sexually transmitted diseases(STDs)in China.There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections.Thus,this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair,comiDunity-based randomized intervention trial carried out in 12 cities in three provinces in China.Methods:Four cities from Guangxi Zhuang Autonomous Region,four from Yunnan Province,and four from Hunan Province were paired and participants received either the intervention package(including condom promotion,HIV and syphilis testing,reimbursement for syphilis treatment costs,and free anti-retroviral therapy or the current standard of care.Venue-based,convenience sampling was used to recruit FSWs.A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months.Generalized linear mixed models(GLMM)were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs.Results:A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up.GLMM results showed that syphilis infeaion was reduced by 49%in the intervention group compared to the current standard of care group(P=0.0378,OR=0.51;95%CI:0.27-0.96).FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old(P<0.0001,OR=2.38,95%CI:1.55-3.65).The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education(P<0.05,OR=0.43,95%CI:0.63-0.93).Conclusions:This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs.Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs.Trial registration:CHiCTR-TRC-12002655.

关键词： China Female sex workers Human immunodeficiency virus Syphilis