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Reductions in sexually transmitted infections associated with popular opinion leaders in China in a randomised controlled trial
  1. Mary Jane Rotheram-Borus1,
  2. Zunyou Wu2,
  3. Li-Jung Liang1,
  4. Li Li1,
  5. Roger Detels3,
  6. Jihui Guan4,
  7. Yueping Yin4,
  8. Dallas Swendeman1,
  9. the NIMH Collaborative HIV/STD Prevention Trial Group*
  1. 1Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California, USA
  2. 2National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
  3. 3School of Public Health, University of California, Los Angeles, California, USA
  4. 4Fujian Center for Disease Control and Prevention, Fuzhou, China
  1. Correspondence to Dr Mary Jane Rotheram-Borus, University of California, Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024, USA; rotheram{at}


Objectives A community level randomised controlled trial of a Community Popular Opinion Leader (C-POL) intervention to reduce bacterial and viral sexually transmitted infections (STIs) and unprotected extramarital sex was carried out over 2 years in five countries. The main study results did not find significant intervention effects. This paper presents a sub-analysis examining the differential intervention impacts among high-risk and low-risk participants in the China site.

Methods From 2002 –2006, 3912 migrant market vendors aged 18 and 49 years were recruited at an urban site in China. Markets were randomly assigned to the C-POL intervention (N=20 markets; n=1979) or standard-care control condition (N=20; n=1933). Both study condition venues received HIV/STI education, free condoms, STI testing and treatment, and training for pharmacists in antibiotic treatments. In intervention markets, C-POLs were identified and trained to diffuse messages regarding safer sex, STI treatment and partner discussions of sex. The primary biological outcome was incidence of new STIs (chlamydia, gonorrhoea, syphilis, trichomonas, herpes or HIV). The primary sexual behaviour risk outcome was any unprotected extramarital sex in the prior 3 months.

Results In unadjusted analyses, women had significantly lower rates of STI infection at 24 months in the C-POL intervention (5.7%) compared to controls (8.3%; p=0.043). In mixed-effects regression models, intervention participants with STIs at previous assessments were about half as likely to have STIs at 24 months (OR 0.47, 95% CI 0.25 to 0.90) compared to controls.

Conclusions The C-POL intervention lowers HIV risk among those at highest risk (ie, with a STI or engaging in high-risk sexual activities) rather than the general population.

Trial registration identifier NCT 00710060.

  • AIDS
  • intervention studies
  • sexual behaviour
  • trichomonas

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  • * Carlos Caceres (Cayetano Heredia University); David Celentano (Johns Hopkins University); Thomas Coates (David Geffen School of Medicine, University of California, Los Angeles (UCLA); Tyler Hartwell (RTI International); Danuta Kasprzyk (Battelle); Jeffrey Kelly (Medical College of Wisconsin); Andrei Kozlov (Biomedical Center, St. Petersburg State University); Willo Pequegnat (National Institute of Mental Health); Mary Jane Rotheram-Borus (UCLA); Suniti Solomon (YRG Centre for AIDS Research and Education); Godfrey Woelk (University of Zimbabwe); Zunyou Wu (Chinese Center for Disease Control and Prevention).

  • Funding This study was funded by the National Institute of Mental Health (NIMH) grant number U10MH61513: a five-country agreement conducted in China, India, Peru, Russia and Zimbabwe (trial registration: NCT 00710060; registrant: Dr Li Li).

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the UCLA Internal Review Board; Institute Review Board of the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.

  • Provenance and peer review Not commissioned; not externally peer reviewed.