A survey of HIV infection and related high-risk factors among men who have sex with men in Suzhou,Jiangsu,China

A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus （HIV） infection status and related high risk factors among men who have sex with men （MSM） in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases （STDs）. Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosex- ual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% （20/280） and 15.0% （42/280）, respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB $ 1,000 （OR=4.83,95% CI=1.44-16.22）, subjects who often went to bars for sexual partners （OR=2.25, 95%CI=1.21-4.20）, and subjects who had more than one sexual partner in the past 6 months （OR=0.49, 95%CI=0.25-0.97） and had sex with fixed sexual partners in the past 6 months （OR=0.42, 95%CI=0.25-0.75） were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.

Barriers and facilitators in Pre-exposure Prophylaxis(PrEP)use intention among Chinese homosexual men

Background:Despite strengthened efforts on human immunodeficiency virus(HIV)prevention and control,new HIV infections continue to increase among men who have sex with men(MSM)in China.Pre-exposure prophylaxis(PrEP),a highly effective HIV-prevention tool,has recently been included in China’s Action Plan of HIV Prevention and Control.To promote future PrEP implementation,this study aims to identify the barriers and facilitators in PrEP use intention among MSM in China.Methods:In 2018,a cross-sectional survey was conducted among 300 MSM in Nanjing,Jiangsu Province.Questions on demographics,sexual behavior(including a seven-item high-risk behavior index),PrEP use intention,PrEP-related awareness and accessibility,and a seven-item public HIV stigma scale were included in the questionnaire.Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP use intention.Results:Overall,44.67%of the participants had more than two male sexual partners and 5.56%had HIV-positive sexual partners.Only 57.00%had heard of PrEP and only four(1.33%)participants had used PrEP.However,75.34%expressed the willingness to use oral PrEP if its efficacy was assured.The beliefs that“PrEP can prevent HIV if taken as prescribed”(adjusted odds ratio(AOR)=4.84,P<0.001)and“PrEP can be scaled up in the community”(AOR=3.24,P<0.001)were positively associated with oral PrEP use intention.Concerns of side effects were negatively associated with oral PrEP use intention(AOR=0.32,P=0.006).Further,77.00%of the participants would choose injectable or implanted PrEP instead of oral PrEP.One of the PrEP stigma items,“Not certain if doctors can prescribe PrEP if I go to the clinic”was positively associated with the intention to use injectable or implanted PrEP(AOR=3.03).The items“Heard of PrEP”(AOR=2.74)and“PrEP can prevent HIV if taken as prescribed”(AOR=2.65)were also positively related to the intention to use injectable or implanted PrEP.The most common concerns regarding PrEP use were efficacy(44.67%)and side effects(38.67%).The most common reasons for using injectable and implanted PrEP were adherence(81.94%and 77.86%,respectively)and privacy concerns(56.48%and 55.00%,respectively).Affordable price and coverage by health insurance were the driving factors for PrEP use.Conclusion:Given the low level of awareness of PrEP-related information in China,it’s necessary to provide interventions for high-risk individuals and communities,in order to increase their awareness and knowledge of PrEP.Furthermore,additional alternatives to HIV prevention,such as long-acting injectable or implanted PrEP,should be investigated to reduce the risk of HIV infection in at-risk MSM.Even if this programme could be approved by the National Medical Products Administration of China and implemented,a supportive social environment for MSM is essential during its implementing.

Exploration for the Priority of HIV Intervention:Modelling Health Impact and Cost-Effectiveness—Six Cities,Eastern China,2019-2028

Introduction:In order to enhance the effectiveness of resource allocation,regions must tailor their responses to their specific epidemiological and economic situations.Methods:Utilizing Spectrum software,we projected the cost-effectiveness of 10 chosen HIV interventions in six cities in eastern China from 2019 to 2028.We assessed three scenarios—Base,Achievable,and Idealized—for each city.The analysis included the projected number of HIV infections and deaths averted,as well as the incremental costeffectiveness ratios for each intervention in the six cities.Results:In Shijiazhuang,Wuxi,Yantai,and Zhenjiang,cities with initially low antiretroviral therapy(ART)coverage,ART showed significant effectiveness,especially for males.Conversely,in Foshan and Ningbo,where ART coverage was notably high,oral pre-exposure prophylaxis(PrEP)for men who have sex with men(MSM)proved effective in the Idealized scenario.MSM outreach,ART for males,and ART for females demonstrated cost-effectiveness across all six cities in both Achievable and Idealized scenarios at the predefined thresholds for each city.Discussion:Maintaining an appropriate coverage rate for outreach to MSM can lead to costeffectiveness.In cities with low ART coverage,scaling up ART remains a crucial intervention.In regions with high ART coverage,consideration may be given to the utilization of oral PrEP for MSM individuals,requiring budget allocation.

Estimating Costs of the HIV Comprehensive Intervention Using the Spectrum Model--China,2015-2019

Introduction:In order to facilitate human immunodeficiency virus(HIV)treatment and prevention,the resource needs for HIV national strategic planning in developing regions were estimated based on Spectrum,the universal HIV costeffectiveness analysis software.Methods:Based on the theoretical framework of Spectrum,the study developed a cost measurement tool for HIV,and calculated the cost of HIV prevention and control in 6 sampled cities in China during 2015–2019 using the Spectrum model.Results:From 2015 to 2019,the average annual costs for HIV prevention and control for Shijiazhuang,Yantai,Ningbo,Zhenjiang,Foshan,and Wuxi cities were 46.78,47.55,137.49,24.73,74.37,and 58.30 million Chinese yuan(CNY),respectively.The per capita costs were 4.37,6.73,17.33,7.77,17.56,and 8.91 CNY,respectively.In terms of the cost structure,the ratio of preventive intervention funds to therapeutic intervention funds(antiviral treatment)varied in sampled cities.Discussion:Developing comprehensive and systematic HIV fund calculation methods can provide a research basis for rational resource allocation in the field of HIV.