The article on HIV and syphilis among migrants in eastern China (1)
sheds light on a very important topic of great public health import – to
what extent will the enormous rural to urban migration happening across
China affect sexual behaviors, STI risk, and HIV transmission. However,
there are several important caveats that were not discussed in this paper
that should be considered.
The article on HIV and syphilis among migrants in eastern China (1)
sheds light on a very important topic of great public health import – to
what extent will the enormous rural to urban migration happening across
China affect sexual behaviors, STI risk, and HIV transmission. However,
there are several important caveats that were not discussed in this paper
that should be considered.
First, the individuals included under the
umbrella of the term “migrant” are far too numerous and heterogenous to
comprise a single sexual risk-taking profile. Rural to urban migrant
workers in China number number over 100 million, and include populations
like PhD graduates traveling to urban areas to take teaching positions in
addition to female sex workers. Although subsets of migrants (e.g, young,
poor, unmarried females who work in salons) may have increased sexual
risk, the broader groups encompassed by the terms migrant or migrant
worker are too large for meaningful prevention or intervention efforts.
Second, one does not need to invoke comparisons of African nations or
other regions to understand that some subsets of rural to urban migrants
in China likely have increased sexual risk taking and higher STI/HIV
prevalence compared to their rural or urban counterparts. Behavioral
(2,3) and serologic (4) studies suggest that sexual risk taking is
increased among some groups of migrants, including women. Both sexes are
part of China’s rural to urban migrants, and there are plausible social
explanations for both male and female subsets of migrants to have
increased sexual risk, including: 1) migrants are away from their “home
town” and the social structures and cultural norms that curb commercial
sex interactions in rural areas; 2.) migrants lack access to reliable
STI/HIV testing and reproductive health services; 3.) poor rural to urban
female migrants with limited education have problems finding official
jobs, but can earn money by selling sex; 4.) China’s eastern urban regions
have higher STI seroprevalence than most rural areas, making sex in urban
areas potentially more risky. Understanding the sexual risk and STI/HIV
dynamics of China’s migrants requires studies that compare these groups to
their rural and urban counterparts. It is encouraging that some small
studies of migrants in China have revealed low STI and HIV
prevalence,(1,5) but more work needs to be done among high risk subsets
of migrants to understand STI/HIV risk and guide prevention efforts among
these vulnerable groups.
References
1. Hesketh T, Li L, Ye X, Wang H, Jiang M, Tomkins A. HIV and
syphilis in migrant workers in eastern China. Sex Transm Infect 2006;
82:11-14.
2. Hong Y, Stanton B, Li X, Yang H, Lin D, Fang X, et al. Rural-to-
Urban Migrants and the HIV Epidemic in China. AIDS Behav 2006; 19: 1-10.
3. Li X, Stanton B, Fang X, Lin D, Mao R, Wang J. HIV/AIDS risk
behavior and perception among young rural-to-urban migrants in China.
AIDS Educ Prev 2004; 16: 538-56.
4. Liu H, Li X, Stanton B, Liu H, Liang G, Chen X, et al. Risk
factors for sexually transmitted disease among rural-to-urban migrants in
China: implications for HIV/sexually transmitted disease prevention. AIDS
Patient Care STDs 2005; 19: 49-57.
5. He N, Detels R, Zhu J, Jiang Q, Chen Z, Fang Y, et al.
Characteristics and sexually transmitted diseases of male migrants in a
metropolitan area of Eastern China. Sex Transm Dis 2005; 32: 286-92.
AIDS cases were first identified in 1981,in the
United States. Researchers have traced cases back to
1959. There are millions of diagnosed cases
worldwide, but there is no cure. There are about
thirty million people in the world who are currently
infected with HIV. China is the world largest
population country in the world. Potentiality,
manpower & security were able to attract world famous
in...
AIDS cases were first identified in 1981,in the
United States. Researchers have traced cases back to
1959. There are millions of diagnosed cases
worldwide, but there is no cure. There are about
thirty million people in the world who are currently
infected with HIV. China is the world largest
population country in the world. Potentiality,
manpower & security were able to attract world famous
investor. Many foreign investor, invest in here. So
China plays an important role in the world markets.
By the way, AIDS epidemic is knocking the door.
UNAIDS, WHO and Government, the study estimated that
650,000 people have HIV/AIDS in China, down from the
government's 2003 estimate of 840,000 cases. The
revision is due mainly to the earlier study's
overestimation of the number of people infected
through blood-buying schemes, said Deputy Health
Minister Wang Longde.
The HIV/AIDS programme specialist Mr. Mohammad
Khairul Alam said, “several social norms and immature
behavior fueled of this disease to scatter rapidly.
There are several social components link to develop
this harmful situation. Poverty-behind to force it,
Gender discrimination plays a vital role; Frustration
& risk behavior help to sink humanity resulting
infection. The link between poverty & gender
discrimination are help to decline socio economic
prosperity. This link creates several anti social
poisonous issues also. Such as trafficking to
prostitute, sell sex for earn or living, break down
family norm to create frustration and driven drug
point. We notice easily that Illiteracy is the main
watchword of all circumstance. So it is not easy to
remove it from the society, several programs & strategy are needed to
gain sustainable position”.
UN officials said the new figure is more accurate
than past estimates in part because more surveillance
sites have been set up during the last two years. The
figure is within an estimated range of 540,000-
760,000 HIV/AIDS cases, UN officials said.
Of the 25,000 people who died of AIDS in China last
year, 10,000 acquired their infections through blood-
buying schemes, said the Health Ministry. The high
mortality comes despite estimates that those infected
through blood-buying, mostly poor farmers, comprise a
small proportion of total AIDS cases in China.
"Make no mistake, China's AIDS epidemic is growing,"
said Hank Bekedam, WHO's chief China
representative. "With an estimated 70,000 new
infections in 2005, the epidemic here shows no signs
of abating." "The new numbers should not mask the
fact that HIV infections are on the rise. we fear the
number of new infections this year will be even
higher and this trend could continue in the future,"
Bekedam said.
The Rainbow Nari O Shishu Kallyan Foundation
identified four major approaches in a groundbreaking
study on spread out HIV in Asia. This study undertook
by comparing of social-economic norm, family pattern,
economic dependency, cause of mounting sex
industries, gender discrimination status & global
analysis fact. There are four factors that appear to
play a crucial role in HIV transmission in Asian
Countries: Injection/ intravenous drug use (By
sharing needle), female sex work (Due to lack of safe
sex knowledge), gender discrimination (which
indirectly force females commercial or non-commercial
sex), Same sex/ homosexually/ Hizra (Due to lack of
HIV/AIDS information, because they act invisible in
this society). Poverty & illiteracy fueled it
proportionally.
About half the 70,000 new infections were sexually
transmitted, while most others were acquired through
intravenous drug use, the study said. The number of
sexually transmitted cases exceeded the number of
cases through IDU, worrying officials that the
epidemic has moved into the general populace, and it
has killed many people. So people need to be more
aware and protect themselves so they don't become
another statistic, because HIV and AIDS are serious,
deadly, and they will be with us for a long time.
There will not be a cure found anytime soon, but
hopefully there will be a cure found. We have to
think AIDS couldn’t backward the present development
in China.
References
Agence France Presse, Rainbow Nari O
Shishu Kallyan Foundation.
Nucleic acid amplification tests for gonorrhoea are currently
being extensively evaluated on first catch urine samples in men and women,
self taken vaginal swabs and endocervical swabs. There is little doubt
that in the near future we will have a simple urine screening test that
will test for chlamydia and gonorrhoeae and possibly even mycoplasma
genitalium. However, the results published by Stanley...
Nucleic acid amplification tests for gonorrhoea are currently
being extensively evaluated on first catch urine samples in men and women,
self taken vaginal swabs and endocervical swabs. There is little doubt
that in the near future we will have a simple urine screening test that
will test for chlamydia and gonorrhoeae and possibly even mycoplasma
genitalium. However, the results published by Stanley & Todd1 show a
high number of positive NAATs not confirmed by culture. This is in stark
contrast to our one year experience of NAAT, using APTIMA COMBO 2 2.
Of 82 positive NAAT's 74 were confirmed by culture at the same site
giving 8 extra positive NAATs. However, five of these were either positive
by microscopy or culture at a different site, leaving us with just 3 cases
with no culture confirmation. However, checking on contact data, who all
had gonorrhoeae, made us reasonably certain that these 3 extra unconfirmed
NAAT's were true positives. NAAT did not miss a single case of GC that
was culture positive.
The issue of false positives is an experience the specialty is well
used to dealing with, i.e. when chlamydia testing changed from the gold
standard of tissue culture there were also claims of poor sensitivity of
newer tests giving a high false positive rate, but this was later shown to
be untrue.
Our results allow us to continue with confidence in NAAT of first
catch urines, self taken swabs or endocervical swabs for gonorrhoeae and
chlamydia. The urine testing, of course, allows nurse led clinics in GUM
and community settings where examination is unnecessary.
Dr Colm O'Mahony
Countess of Chester Hospital NHS Foundation Trust
Chester CH2 1UL
References
1. Stanley B, Todd A. Testing for Neisseria gonorrhoeae by nucleic acid amplification testing of
chlamydia samples using Roche Cobas Amplicor in a rural area in the north
of England does not find more gonorrhoeae in primary care.
STI 2005 Vol 81.No 6;518.
2. O'Mahony et al. One year experience of APTIMA COMBO 2 transcription mediated amplification (TMA) for chlamydia and gonorrhoeae in a District General Hospital.
Int J STD & AIDS 2006 - in press.
Dear Editor,
The article on HIV and syphilis among migrants in eastern China (1) sheds light on a very important topic of great public health import – to what extent will the enormous rural to urban migration happening across China affect sexual behaviors, STI risk, and HIV transmission. However, there are several important caveats that were not discussed in this paper that should be considered.
First...
Dear Editor,
AIDS cases were first identified in 1981,in the United States. Researchers have traced cases back to 1959. There are millions of diagnosed cases worldwide, but there is no cure. There are about thirty million people in the world who are currently infected with HIV. China is the world largest population country in the world. Potentiality, manpower & security were able to attract world famous in...
Dear Editor,
Nucleic acid amplification tests for gonorrhoea are currently being extensively evaluated on first catch urine samples in men and women, self taken vaginal swabs and endocervical swabs. There is little doubt that in the near future we will have a simple urine screening test that will test for chlamydia and gonorrhoeae and possibly even mycoplasma genitalium. However, the results published by Stanley...
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