Correlates of HIV infection among transgender women in two Chinese cities

Background:In an era when HIV transmission has been on the rise among men who have sex with men(MSM),transgender women may play a considerable role in China’s current HIV epidemic as a potential“bridge”of HIV transmission between homosexual and heterosexual populations.We sought to understand the risk behaviours and factors associated with HIV infection among transgender women in two cities in China.Methods:From January to December 2016,we recruited transgender women with the help of community-based organizations(CBOs)through a wide range of methods,including snowball sampling.After recruitment,we asked participants to fill out a structured questionnaire including questions about socio-demographics,sexual behaviours,condom use,substance use and uptake of health care services.HIV infection status was determined by using two different rapid testing reagents.Results:Among 498 subjects enrolled in this study,233 were from Shanghai and 265 were from Tianjin.The median age was 30 years(range:18-68;IQR:24-33).Of them,337(67.7%)preferred feminine dress,13(2.6%)had undergone transsexual operation and 68(13.7%)had used hormones for transition purposes.Nearly half(45.6%)reported having regular partners,and 351(70.5%)had casual partners.Regarding condom use,81.5%reported not always using condoms with stable partners,and 70.9%reported not using condoms with casual partners.Twentyfive(5.0%)had a history of buying sex and fifty-one(10.2%)had a history of selling sex in the past three months.A total of 200(40.2%)participants had used at least one kind of controlled substance in the past six months.The most commonly used substances were amyl nitrates(rush popper)(99.5%)and 5-MeO-DiPT(20.0%).Among rush popper users,170(85.4%)reported always having sex while on the drug,and 177(88.9%)reported increased sexual pleasure after using the drug.The HIV infection risk factors identified in our study were being located in Shanghai(aOR=9.35,95%CI=3.89-22.49),selling sex in the past three months(aOR=3.44,95%CI=1.31-9.01),and substance use in the past six months(aOR=5.71,95%CI=2.63-12.41).Conclusions:Transgender women bear a high HIV burden in the two Chinese cities.Those involved in commercial sex tended to have inconsistent condom use,leading to high risk of HIV infection.Substance use was an independent risk factor of HIV infection by increasing sexual activities and unprotected sex,which indicated an aggravated and complex situation with possible interacting syndemic factors that could cumulatively facilitate sexual risk behaviours and HIV infection in transgender women.There is an urgent need for innovative and appropriate HIV prevention programmes targeting this unique population.Efforts should be made to provide them with tailored services including persuasive communication on consistent condom use,substance use counselling and related referral services,all with the goal of reducing HIV epidemic among transgender women.

Serum carbohydrate antigen (CA) 19-9 as a prognostic factorin cholangiocarcinoma: A meta-analysis

This study was performed to determine the prognostic role of preoperative serum carbohydrate antigen(CA)19-9 levels in the survival of patients with cholangiocarcinoma.Articles published up to June 1st,2010 that evaluated preoperative CA19-9 levels and the prognosis of cholangiocarcinoma were collected for meta-analysis.The required information for calculating indivi-dual relative risk(RR)was extracted from the studies,and a combined overall RR was estimated.Nine eligible studies were included.One study dealt with extra-hepatic cholangiocarcinoma,while the other eight studies analyzed intra-hepatic cholangiocarcinoma.The mean methodolo-gical quality score was 74.1%,ranging from 65.5%to 82.5%.The overall RR for the nine studies was 1.28(95%confidence interval=1.10–1.46),and the Z-score for overall effect was 13.83(P<0.001).The association between serum CA19-9 level and lymph node involvement was also assessed.The combined RR was 1.471(95%confidence interval=0.411–5.264)and Z-score for overall effect was 0.59(P=0.553).CA19-9 levels were associated significantly with the prognosis of patients with cholan-giocarcinoma.This meta-analysis shows that elevation of preoperative CA19-9 levels is correlated with a poor prognosis of patients with cholangiocarcinoma.However,larger scale and randomized studies are needed to draw a more substantive conclusion.

HIV incidenee and risk factors among transgender women and cisgender men who have sex with men in two cities of China:a prospective cohort study

Background:HIV epidemic among men who have sex with men(MSM)remains a major public health concern in China.Despite a growing body of research on transgender women worldwide,little is known about Chinese transgender women within MSM.We sought to estimate HIV incidence and distinguish risk factors of HIV acquisition among them from that among cisgener(non-transgender)MSM(cis-MSM).Methods:We conducted an open cohort study among Chinese MSM,including those who were identifed as transgender in Shanghai and Tianjin.Participants were initially recruited by local community-based organizations from January to June,2016,and were followed up approximately every 6 months until June 2018.At each visit,a structured questionnaire was used to gather information on demographics,sexual risk behaviors,and HIV status.HIV incidence was calculated as the number of seroconversions divided by total number of person-years of follow-up among HIV-negatives at baseline.Risk factors of HIV acquisition were assessed by univariate and multivariate Cox regression models with time-dependent variables.Results:A total of 1056 participants contributed 1260.53 person-years(PYs)of follow-up,33 HIV seroconversions occurred during the follow-up period,yielding an estimated HIV incidence of 2.62(95%CI 1.80–3.68)per 100 PYs.HIV incidence among transgender women was 4.42 per 100 PYs,which was signifcantly higher than that of 1.35 per 100 PYs among cis-MSM,demonstrating a threefold higher odds of HIV infection than cis-MSM.For transgender women,those lived locally≤2 years(adjusted hazard ratio[aHR]=1.76,95%CI 1.13–2.76)and unprotected anal sex last time(aHR=4.22,95%CI 1.82–9.79)were more likely to acquire HIV.For cis-MSM,factors associated with HIV acquisition were frequency of anal sex≥3 times in past one month(aHR=4.19,95%CI 1.06–16.47)and unprotected anal sex last time(aHR=5.33,95%CI 1.52–18.73).Conclusions:Compared to cis-MSM,transgender women were at higher risk of HIV acquisition,highlighting an urgent need of tailored prevention.Future HIV program should consider to include them to ensure that this population in China are not left behind.