Emerging HIV-1 epidemic in China in men who have sex with men

doi:10.1016/S0140-6736(03)13690-2

The Lancet

Volume 361, Issue 9375, 21 June 2003, Pages 2125-2126

https://doi.org/10.1016/S0140-6736(03)13690-2 Get rights and content

Summary

China is currently undergoing a serious HIV-1 epidemic in intravenous drug users, sex workers, and former plasma donors. Little is known, however, about HIV-1 risk in Chinese men who have sex with men. In this study of seroprevalence in such men in Beijing, we recorded 15 (31%, 95% Cl 1·8–5·1) of 481 men infected with HIV-1. Overall, 238 (49%) of participants reported unprotected anal intercourse during the previous 6 months. HIV-1 seropositivity was independently associated with being older than 39 years and having had more than 20 male sexual partners. Most men older than 39 years had been married. Our findings suggest the potential for spread of HIV-1 between men who have sex with men and to their heterosexual partners.

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Many participants had planned to get married to a woman before being diagnosed with HIV infection. In China, MSM (18.25% to 33.5%) are commonly in married heterosexual relationships (Lau et al., 2008), with the majority of MSM (64%) older than 39 years of age having been married (Choi et al., 2003). The diagnosis of HIV had confronted our participants' cultural life trajectories of competency and success, such as marrying a woman and having children to maintain family bloodlines, which are deeply and culturally internalized (Li, Holroyd, & Lau, 2010).
High rates of mental health problems among people living with HIV (PLWH) have been widely reported in the literature; however, an understanding of the socioecological contexts of these presentations remains limited, particularly in China. In order to explore potential socioecological factors associated with mental health problems among newly diagnosed HIV-infected migrant men who have sex with men (MSM), we employed a life profile approach conducting semi-structured in-depth interviews with 31 newly diagnosed HIV-infected MSM residing in a city in Southern China. Participants' life profile accounts outlined their concerns, including internalized stigma, subsistence living, difficulties finding a lover or a stable partner, loss of face, and deviation from filial piety. We contend that targeted interventions should address socio-ecological issues such as migrant adversities, social suffering, and cultural trauma when providing culturally based mental health services for this marginalized population within the context of Chinese society.
HIV prevalence in China: Integration of surveillance data and a systematic review
2013, The Lancet Infectious Diseases
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An estimated 8·3% (95% CI 7·2–9·5) of men who have sex with men have used drugs in the past 6 months.46 Further, roughly 5–25% of Chinese men who have sex with men sell sex to other men;47–53 this group is 1·92 (1·54–2·39) times more likely to use drugs than are other men who have sex with men.10 In view of these interactions, centred around overlaps through drug use within each of these core population groups, drug consumption might be important in the future of HIV transmission in China and adds to the complication of HIV intervention strategies for these overlapping populations.
Asian HIV epidemics are concentrated among particular behavioural groups, but large variations exist in epidemic types, timing, and geographical spread between countries and within countries, especially in China. We aimed to understand the complexity of HIV epidemics in China by systematically analysing prevalence trends by data source, region, population group, and time period.
We collected HIV prevalence data from official national sentinel surveillance sites at the provincial level from Jan 1, 1995, to Dec 31, 2010. We also searched PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from Jan 1, 1990, to Dec 31, 2012, for independent studies of HIV prevalence. We integrated both sets of data, and used an intraclass correlation coefficient test to assess the similarity of geographical pattern of HIV disease burden across 31 Chinese provinces in 2010. We investigated prevalence trends (and 95% CIs) to infer corresponding incidence by region, population group, and year.
Of 6850 articles identified by the search strategy, 821 studies (384 583 drug users, 52 356 injecting drug users, 186 288 female sex workers, and 87 834 men who have sex with men) met the inclusion criteria. Official surveillance data and findings from independent studies showed a very similar geographical distribution and magnitude of HIV epidemics across China. We noted that HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China. Compared with injecting drug users, HIV prevalence in female sex workers is much lower and has stabilised at low levels in all regions except in the southwest. In 2010, national HIV prevalence was 9·08% (95% CI 8·04–10·52) in injecting drug users and 0·36% (0·12–0·71) in female sex workers, whereas incidence in both populations stabilised at rates of 0·57 (0·43–0·72) and 0·02 (0·01–0·04) per 100 person-years, respectively. By comparison, HIV prevalence in men who have sex with men increased from 1·77% (1·26–2·57) in 2000, to 5·98% (4·43–8·18) in 2010, with a national incidence of 0·98 (0·70–1·25) per 100 person-years in 2010. We recorded strong associations between HIV prevalence among at-risk populations in each province, supporting the existence of overlap in risk behaviours and mixing among these populations.
HIV epidemics in China remain concentrated in injecting drug users, female sex workers, and men who have sex with men. HIV prevalence is especially high in southwest China. Sex between men has clearly become the main route of HIV transmission.
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Research LettersEmerging HIV-1 epidemic in China in men who have sex with men

Summary

Lancet

HIV/AIDS: China's titanic peril, 2001 update of the AIDS situation and needs assessment report

Research Letters
Emerging HIV-1 epidemic in China in men who have sex with men