Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China

Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs – a rapidly increasing, vulnerable population in southwest China. 

The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14–66) recruited over five years (2010–2014) from 35 National Sentinel Surveillance sites in Guangxi. 

Analyses included Fisher’s exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. 

Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. 

Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. 

Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.

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By: Yu YJ1, Li X1, Tam CC2, Zhou Y3, Chen Y3, Shen Z3.

• 1a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA.
• 2b Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA.
• 3c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China.
• AIDS Care. 2016 May 30:1-6

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Stigma Against People Living with HIV/AIDS in China: Does the Route of Infection Matter?

In the current study, we tested the hypothesis that people who contracted HIV from "blameless" routes (e.g., blood transfusion, sex with stable partners) are less stigmatized compared to people who contracted HIV from "blamable" routes (e.g., injection drug use, sex with sex workers). A cross-sectional study was conducted among 2,987 participants in Guangxi province, China, between 2012 and 2013. 

We employed both explanatory and predictive modeling strategy by using multivariate linear regression models. In the explanatory models, we assessed the association between routes of infection and three types of stigma (perceived, internalized, and enacted). From identified routes of infection that significantly contributed to higher stigma, we employed predictive modeling to explore predictors for the specific type of stigma. Multiple-imputation was employed for sensitivity analyses. 

Of the total sample, 63% were male and the average age was 42.9 years (ranged between 18 and 88). Multivariate regression models revealed that contraction from commercial sex increased the perceived and internalized stigma, while injecting drug use increased the perceived and enacted stigma after controlling for confounders. 

Among PLWHA who were infected via commercial sex partners, social support was negatively associated with perceived and internalized stigma. Among PLWHA who were infected via injecting drugs, no adherence to antiretroviral treatment was positively associated with perceived stigma, and disclosure of serostatus to others was negatively associated with enacted stigma. 

Knowledge of the association between routes of infection and stigma can guide health professionals and policy makers to develop tailored intervention strategies to mitigate the effects of stigma and enhance HIV care utilization among PLWHA in China.

Below:  Multivariate analysis between stigma and route of infection

Full article at:   http://goo.gl/iVBaPf

By:  Zhang C1, Li X2, Liu Y1, Qiao S2, Zhang L3, Zhou Y4, Tang Z4, Shen Z4, Chen Y4.

• 1Divison of Epidemiology, Vanderbilt University, Nashville, Tennessee, United State of America.
• 2Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United State of America.
• 3Department of Pediatrics, Wayne State University, Detroit, Michigan, United State of America.
• 4Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China. 
• PLoS One. 2016 Mar 16;11(3):e0151078. doi: 10.1371/journal.pone.0151078. eCollection 2016.

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Emotional, Physical & Financial Burdens of Stigma Against People Living with HIV/AIDS in China

Numerous researches have shown pernicious effects of stigma against people living with HIV/AIDS (PLWHA). However, no available studies have reported these negative effects including emotional, physical to financial burdens to PLWHA. 

In the current study, we aim to explore different types of stigma (e.g., perceived, internalized and enacted) and the relevant consequences among PLWHA in China. A cross-sectional study was conducted from 2012 to 2013 in the Guangxi Autonomous Region in China. The validated Berger HIV Stigma Scale was used to measure various types of stigma. We employed a series of linear, logistic and polytomous regression models to assess the association between stigma and different consequences while accounting for potential confounders for each specific model. 

Of the total sample, 2987 PLWHA provided valid responses with 63% being male and having an average age of 42.9 years. Perceived, internalized and enacted HIV stigma were prevalent among participants, and resulted in various burdens with different magnitudes in their life contexts. 

Specially, PLWHA who reported higher perceived and internalized stigma were more likely to be imposed on emotional and physical burdens (p < .05). People who reported higher enacted stigma had heavier financial burden compared to their peers (p < .05). 

Our findings revealed that devastating consequences of HIV-related stigma in China. The prevalent stigmatizing attitudes have pushed PLWHA to the fringes of society and affected them at multiple aspects in their life context. 

We call for tailored efforts to overcome stigma and discrimination against PLWHA.

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By:  Zhang C¹, Li X², Liu Y¹, Qiao S², Zhang L³, Zhou Y⁴, Shen Z⁴, Tang Z⁴.

¹ Vanderbilt Institute of Global Health , Vanderbilt University , Nashville , TN , USA.

² Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.

³ Department of Pediatrics , Wayne State University , Detroit , MI , USA.

⁴ Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China.

AIDS Care. 2016 Feb 17:1-8.

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Cigarette Smoking among Chinese PLWHA: An Exploration of Changes in Smoking After Being Tested HIV Positive

Prevention and cessation of Tobacco use among persons living with HIV/AIDS (PLWHA) represents a significant challenge for HIV/AIDS patient care in China and across the globe. Awareness of HIV-positive status may alter the likelihood for PLWHA smokers to change their smoking habit. 

In this study, we tested the risk enhancement and risk reduction hypotheses by assessing changes in cigarette smoking behavior among PLWHA after they received the positive results of their HIV tests. Cross-sectional survey data collected from a random sample of 2973 PLWHA in care in Guangxi, China were analyzed. Changes in cigarette smoking after receiving the HIV-positive test results, as well as the current levels of cigarette smoking were measured. 

Among the total participants, 1529 (51.7%) were self-identified as cigarette smokers, of whom 436 (28.9%) reduced smoking and 286 (19.0%) quit after receiving their HIV-positive test results. Among the quitters, 210 (73.9%) remained abstinent for a median duration of two years. There were also 124 (8.2%) who increased cigarette smoking. Older age, female gender, more education, and receiving antiretroviral therapy were associated with quitting. In conclusion, our study findings support the risk reduction and risk enhancement hypotheses. 

A large proportion of smoking PLWHA reduced or quit smoking, while a small proportion increased smoking. Findings of this study suggest that the timing when a person receives his or her HIV-positive test result may be an ideal opportunity for care providers to deliver tobacco cessation interventions. 

Longitudinal studies are indicated to verify the findings of this study and to support smoking cessation intervention among PLWHA in the future. further investigated.

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By: Wang Y1, Chen X1, Li X2, Wang Y1, Shan Q2, Zhou Y3, Shen Z3.

• 1 Department of Epidemiology , University of Florida , Gainesville , FL , USA.
• 2 Pediatric Prevention Research Center , Wayne State University , Detroit , MI , USA.
• 3 Guangxi Center for Disease Control and Prevention , Nanning , Guangxi , People's Republic of China.  

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The Mediating Role of Individual Resilience Resources in Stigma-Health Relationship among People Living with HIV in Guangxi, China

Despite the vigorous global efforts to reduce stigma, HIV-related stigma continues to undermine the health status of people living with HIV (PLHIV). Internalized HIV stigma may cause stress adversely affecting the health of PLHIV. Resilience is the process of an effective coping and positive adaption in the face of adversities. To date, limited data are available on the mediating role of resilience in the relationship of internalized HIV stigma and health status among PLHIV in China. 

A cross-sectional survey was conducted among 2987 PLHIV in Guangxi Autonomous Region (Guangxi) in China. A mediation analysis was employed and Sobel test was used to test the mediation effect of individual resilience. 

• Of the 2987 PLHIV, 62.8% were men. 
• The mean age of the sample was 42.5 years. 
• Over 57.7% of PLHIV reported their overall health status being poor. 
• About 72% of PLHIV reported experiencing internalized HIV stigma. 
• Internalized HIV stigma had a negative direct effect on self-rated health status. 
• Individual resilience resources mediated the relationship between internalized HIV stigma and self-rated health status. 

Sobel test confirmed the mediation effect of resilience. Resilience as a protective factor might buffer the effect of internalized HIV stigma on health status. 

Multilevel interventions are needed to foster resilience of PLHIV in order to mitigate the negative impact of HIV stigma and to improve the overall health status of PLHIV.

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By: Zhang L1, Li X1, Qiao S1, Zhou Y2, Shen Z2, Tang Z2, Shah I3, Stanton B1.

• 1a Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics , Wayne State University School of Medicine , 4707 St Antoine Street, Hutzel Building, Suite W534, Detroit , MI 48201-2196 , USA.
• 2b Guangxi Center for Disease Control and Prevention , Nanning , China.
• 3c Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA.  

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Contextual Influence on Condom Use in Commercial Sex Venues: A Multi-Level Analysis among Female Sex Workers & Gatekeepers in Guangxi, China

This study aims to assess the influence of commercial sex venues on consistent condom use among female sex workers (FSWs) and to examine associations between individual and venue level factors and consistent condom use with clients. Analysis was based on a sample of 637 FSWs and 123 gatekeepers from 51 venues in Guangxi, China. 

Multi-level logistic regression using Bayesian simulation via Markov Chain Monte Carlo was applied to investigate whether FSWs' individual propensity to use condom with clients was statistically dependent on the venue of working. Multi-level modeling revealed considerable variability across venues in the likelihood of consistent condom use with clients among FSWs. Characteristics at both individual and venue levels helped to explain the observed variation. Certain venue-level factors exerted their influence on condom use over and above the effect of individual-level characteristics. 

The contextual influence exerted on condom use behaviors among FSWs may imply a potential to harness the path to individual behaviors from a higher and more dominant level, and shed light on the design of more effective sexual risk reduction intervention among venue-based FSWs.

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By: Chen Y1, Li X2, Shen Z3, Zhou Y3, Tang Z3, Huedo-Medina TB4.

• 1Department of Psychology, University of Connecticut, Storrs, CT, USA
• 2Carman and Ann Adams Department of Pediatrics, Prevention Research Center, Wayne State University School of Medicine, Detroit, Michigan, USA.
• 3Guangxi Center for Diseases Control and Prevention, Nanning, Guangxi, China.
• 4Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA. 

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Drinking Reasons & Alcohol Problems by Work Venue among Female Sex Workers in Guangxi, China

Alcohol use is a key determinant of sexual risk behaviors, but pathways to alcohol use in the context of commercial sex still remain unclear. The present study explores reasons for drinking and their roles on alcohol use problems among female sex workers (FSWs) in different types of commercial sex venues.

In 2009, a sample of 1,022 FSWs from Guangxi, China completed a survey containing a 10-item Alcohol Use Disorders Identification Test (AUDIT) and a 28-item measure of reasons for drinking. Factor analysis revealed five reasons for drinking: suppression, disinhibition, work requirement, sexual enhancement, and confidence booster.

All identified reasons except confidence booster appeared to be related to a higher tendency of developing alcohol use problems among FSWs. Types of commercial sex venues moderated the relationship between work requirement and alcohol use problems.

Alcohol-risk reduction interventions among this population need to provide them with alternative approaches to regulate emotions and modify their misconceptions about alcohol's sexual enhancing function. More attention is needed to FSWs' vulnerability to the negative influence of occupational drinking.

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By: Chen Y1, Li X, Shen Z, Zhou Y, Tang Z.

1 Wayne State University , Detroit, Michigan , USA.

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Characteristics of Commercial Sexual Behavior and the Risk Factors Analysis of HIV Infection among the Old Male Clients, in Guangxi

To understand the current situation and characteristics of commercial sexual behavior among old male clients in Guangxi, and to explore the associated risk factors of HIV infection.

The areas in Guangxi where more old male HIV cases were reported followed by survey on those male clients who were over 60 years of age, were selected. A total of 5 ml blood sample was collected to test antibodies of HIV and syphilis. Risk factors were calculated by the multivariate logistic analysis method.

A total of 1 236 questionnaires were completed in the survey. 65.61% of the old male clients were from low-grade venues with 53.64% of them never using a condom when engaging in commercial sex behavior. 47.33% of them patronized sex workers for around 10 years. 53.32% of them patronized prostitutes not less than 2 times in the last 30 days. Thirty subjects were HIV positive (2.43%) and 40 were syphilis positive (3.24%). Factor as 'having fixed partners' appeared protective for the old male clients of HIV infection, with a history of patronizing sex workers from 1 to 5 years. Frequency of patronizing sex workers not less than 4 times in the last 30 days seemed the high risk factor of HIV infection.

Older-aged male clients showed high HIV and syphilis infection rates in Guangxi, and most of them were using the low-grade venues. Commercial sexual behaviors in the areas would include early and, frequent exposure, but with poor protections. High risk factors of HIV infection might relate to "no fixed sexual partners" and "frequently commercial sexual behavior"

Via: http://goo.gl/2IGkrk and http://goo.gl/vSrEe7

By: Lu H1, Zhu Y2, Wu X1, Chen H1, Luo L1, Cai K1, Li J1, Qin C3, Zhang S4, Liang Y5, Li L6, Zhang H1.

• 1Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
• 2Guigang City People's Hospital. Email: ggzhuyujia@163.com.
• 3Guigang City Center for Disease Control and Prevention.
• 4Binyang Center for Disease Control and Prevention.
• 5Luzhai Center for Disease Control and Prevention.
• 6Qintang Center for Disease Control and Prevention. 

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Acceptability of Male Circumcision among College Students in Medical Universities in Western China: A Cross-Sectional Study

Male circumcision (MC) has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore MC’s acceptability and the factors associated with MC among college students in medical universities in western China.

A cross-sectional study was carried out in three provinces in western China (Guangxi, Chongqing and Xinjiang) to assess the acceptability of MC as well as to discover factors associated with the acceptability among college students in medical universities. A total of 1,790 uncircumcised male students from three medical universities were enrolled in this study. In addition, 150 students who had undergone MC were also enrolled in the survey, and they participated in in-depth interviews.

Of all the uncircumcised participants (n = 1,790), 55.2% (n = 988) were willing to accept MC. Among those who accepted MC, 67.3% thought that MC could improve their sexual partners’ hygiene, 46.3% believed that HIV and sexually transmitted diseases (STDs) could be partially prevented by MC. The multivariable logistic regression indicates that MC’s acceptability was associated with three factors: the redundant foreskin (OR = 10.171, 95% CI = 7.629–13.559), knowing the hazard of having a redundant foreskin (OR = 1.597, 95% CI = 1.097–2.323), and enhancing sexual pleasure (OR = 1.628, 95% CI = 1.312–2.021). The in-depth interviews for subjects who had undergone MC showed that the major reason for having MC was the redundant foreskin (87.3%), followed by the benefits and the fewer complications of having MC done. In addition, most of these participants (65.3%) said that the MC could enhance sexual satisfaction.

MC’s acceptance among college students in medical universities is higher than it is among other populations in western China. An implementation of an MC programme among this population is feasible in the future.

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By:

Junjun Jiang, Jinming Su, Xiaobo Yang, Wei Deng, Jiegang Huang, Bingyu Liang, Li Ye, Hao Liang

Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China

Hao Liang

Guangxi Medical Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China

Mingbo Huang, Qian Wang

Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia, 30310, United States of America

Bo Qin

The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China

Halmurat Upur

School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China

Chaohui Zhong

School of Public Health, Chongqing Medical University, Chongqing, 400016, China

Qianqiu Wang

National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, 210042, China

Yuhua Ruan

State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, 102206, China


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