What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. 

This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. 

In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. 

These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.

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By:  Mantell JE¹, LeVasseur MT, Sun X, Zhou J, Mao J, Peng Y, Zhou F, DiCarlo AL, Kelvin EA.

¹ HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.

Glob Public Health. 2015;10(8):947-67. doi: 10.1080/17441692.2015.1045918.

  

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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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Syphilis among middle-aged female sex workers in China: A three-site cross-sectional study

OBJECTIVES:

This study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China.

DESIGN:

A cross-sectional study with respondent-driven sampling (RDS).

SETTING:

A multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014.

PARTICIPANTS:

1245 middle-aged female sex workers who were over 35 years old (about 400 per study site).

MAIN OUTCOME MEASURES:

Unprotected commercial sex, and syphilis and HIV infection were biologically tested and measured.

RESULTS:

The RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases.

CONCLUSIONS:

In contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings.

Below: Location of the three study sites (Qingdao, Hefei, and Nanning)

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

By:  Liu H¹, Dumenci L², Morisky DE³, Xu Y⁴, Li X⁵, Jiang B⁶.

¹Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA.

²Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA.

³Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA.

⁴Department of AIDS/STD Prevention, Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China.

⁵Department of AIDS/STD Prevention, Hefei Center for Disease Control and Prevention, Hefei, Anhui, China.

⁶Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandon, China.

BMJ Open. 2016 May 10;6(5):e010420. doi: 10.1136/bmjopen-2015-010420.

  

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Occupational and demographic factors associated with drug use among female sex workers at the China-Myanmar border

HIGHLIGHTS

• Occupational and personal relationships impacted Burmese sex workers drug use.
• Specifically, client specialization was strongly associated with current drug use.
• Both drug using and non-drug using FSW used condoms at high rates.
• Yet drug using FSW were more likely to report a STI diagnosis.
• Health interventions should empower FSW to manage client-driven drug use.

BACKGROUND:

Within the last decade, the use of amphetamine type stimulants (ATS) has swelled in Myanmar. Regionally, female sex workers have reported turning to ATS for occupational reasons. In doing so, drug-using female sex workers (FSW) face compounded risks for HIV and other sexually transmitted infections (STI). Here, we examine the factors that impact FSW drug use in Muse, a town along the China-Myanmar border.

METHODS:

In 2012, 101 FSW were recruited from entertainment venues and brothels along the Myanmar-Chinese border. Participants participated in a self-administered behavioral survey covering demographics, drug use, sex work, and risk behaviors. Bivariate and regression analyses were conducted in SPSS.

RESULTS:

Thirty four percent of respondents indicated current drug use. ATS derivatives were the most commonly used drugs (87.5%) with injection drug use being nearly non-existent in the sample. Drug using FSWs were older, had engaged in sex work longer, had more Chinese clients, and were more likely to have a previous boyfriend who had used drugs. They were also 3.5 times more likely to report a STI. Client condom use, HIV testing rates, and familiarity with public health resources did not statistically differ by drug use status.

CONCLUSION:

More research is needed to examine how romantic and professional sexual relationships push-and-pull FSW into using drugs. Our results suggest that diverse safer sex strategies, beyond client condom use, should be promoted with drug using FSWs, including strategies that acknowledge the impact of ATS use.

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By:  Hail-Jares K1, Choi S2, Duo L3, Luo Z4, Huang ZJ5.

• 1Department of International Health, School of Nursing and Health Studies, Georgetown University. 3700 Reservoir Road NW, Suite 224, Washington, DC 20057 United States. Electronic address: katie.jares@georgetown.edu.
• 2Department of International Health, School of Nursing and Health Studies, Georgetown University. 3700 Reservoir Road NW, Suite 224, Washington, DC 20057 United States; JW LEE Center for Global Medicine, Seoul National University College of Medicine, Global Center IhwaJang-gil 71 Jongno-gu, Seoul, Republic of Korea. Electronic address: sugychoi@gmail.com.
• 3Yundi Harm Reduction Network, Yunnan Drug Dependency Research Center, 4th floor, 300 Xihuayuan Wujiadui Road, Kunming, Yunnan Province 6500228, China. Electronic address: duolin@hotmail.com.
• 4Yundi Harm Reduction Network, Yunnan Drug Dependency Research Center, 4th floor, 300 Xihuayuan Wujiadui Road, Kunming, Yunnan Province 6500228, China. Electronic address: luozhiluozhi@gmail.com.
• 5Department of International Health, School of Nursing and Health Studies, Georgetown University. 3700 Reservoir Road NW, Suite 224, Washington, DC 20057 United States. Electronic address: Jennifer.bouey@georgetown.edu. 
• Drug Alcohol Depend. 2016 Apr 1;161:42-9. doi: 10.1016/j.drugalcdep.2016.01.026. Epub 2016 Feb 3.

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Romancing the Boundary: Client Masculinities in the Chinese Sex Industry

This paper draws on 24 in-depth interviews and 2 focus-group discussions conducted since 2012 with Hong Kong heterosexual men who buy sex in order to examine men's level of physical and emotional engagement with sex workers under two dominant sexual scripts in contemporary Hong Kong. 

Torn between companionate sexuality, with its companionate model of relationships, and recreational sexuality, with its promiscuous model of sexual pleasure, Hong Kong male clients seek to satisfy their sexual and affective needs through commercial sexual relationships. The term (meaning 'chicken worm', connoting a 'McSex' form of masculinity) refers to those men who seek impersonal sexual release with as many women as they wish, while the term (meaning 'sunken boat' and connoting a 'Titanic' form of masculinity) refers to those men who seek an intense level of emotional intimacy with sex workers. Between these two contrasting types, the majority of respondents fall into a form of 'bounded' masculinity characteristic of men who emphasise control and balance by seeking emotionally responsive women in a time-bound romance. 

By comparing clients' variations in the level of physical and emotional engagement with sex workers, this paper seeks to understand individual differences in client types and offers a new understanding of Chinese male sexuality and relationship formation, and the corresponding health risks (e.g., sexual, emotional) associated with each type.

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By:  Kong TS1.

• 1 Department of Sociology , University of Hong Kong , Hong Kong. 
• Cult Health Sex. 2015;17(7):810-24. doi: 10.1080/13691058.2015.1004197. Epub 2015 Feb 17.

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Social-Context Factors, Refusal Self-Efficacy, and Alcohol Use among Female Sex Workers in China

Excessive alcohol use is considered as a health risk behavior that may produce negative health outcomes. Examining predictors of alcohol use in a social or individual context can advance understanding of why people indulge in alcohol use. 

Our research on female sex workers (FSWs) examined associations among several social-context factors (alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence), refusal self-efficacy, and alcohol use. 

Seven hundred FSWs were recruited from two cities in Southern China. Structural equation modeling (SEM) was used to analyze the direct effects of alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence on FSWs’ alcohol use. In addition, the mediation effects of refusal self-efficacy were also examined in the SEM model. 

Results showed that alcohol use by family members and alcohol use by peers significantly predicted FSWs’ alcohol use; the prediction effect of alcohol use by peers on FSWs’ alcohol use was stronger than that of alcohol use by family members; client-perpetrated pressure or violence directly predicted FSWs’ alcohol use and indirectly influenced FSWs’ alcohol use through refusal self-efficacy; refusal self-efficacy directly predicted FSWs’ alcohol use. Administrators of effective intervention programs focused on alcohol use in China should adopt a multilevel approach to reduce negative social influences, particularly the influence from peer, and sex work establishments on FSWs’ alcohol use. 

Meanwhile, training to improve refusal self-efficacy should also be included in intervention programs to reduce FSWs’ alcohol use.

Below:  Associations among social-context factors, refusal self-efficacy and alcohol use of FSWs (N=688)

Full article at: http://goo.gl/kwYF36

By:  Shaobing Su,1 Xiaoming Li,2,* Danhua Lin,3 Chen Zhang,4 Shan Qiao,2 and Yeujiao Zhou5

¹ Eliot-Pearson Department of Child and Human Development, Tufts University, Medford, MA 02155, USA.

² Carman and Ann Adams Department of Pediatrics Prevention Research Center, Wayne State University School of Medicine, Detroit, MI 48201, USA

³ Institute of Developmental Psychology, Beijing Normal University, Beijing, 100875, China

⁴ Division of Epidemiology, Vanderbilt Institute of Global Health, Nashville, TN, USA

⁵ Center for Disease Control and Prevention, Guangxi, China.

Psychol Health Med. 2015; 20(8): 889–895.

Published online 2014 Oct 15. doi:  10.1080/13548506.2014.966727

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Prevalence of High Risk Behaviors in HIV Infected Persons Aged ≥50 Years in Selected Counties of Yunnan Province

OBJECTIVE:

To understand the prevalence of high risk behaviors and influencing factors among HIV infected persons aged ≥50 years.

METHODS:

Face to face questionnaire interview was conducted among the HIV infected persons selected in Jianshui, Gejiu and Mengzi counties in Yunnan province through random sampling in June 2015. The sample size was 450.

RESULTS:

Among the HIV infected persons surveyed, 41.2% (122/296) had sexual behaviors with their spouses during past year, and the consistent condom use rate was 66.4% (81/122). Among the HIV infected males, 8.9%(28/313) had commercial sexual behaviors during past year, and the consistent condom use rate was 17.9% (5/28). Among the HIV infected females, 0.7% were still engaged in commercial sex service during past year. Among the 450 HIV infected persons, 32(7.1%) reported having casual sex behaviors during past years, and the consistent condom use rate was 18.7% (6/32). The rate of commercial sexual behavior in urban residents (13.4%, 19/115) was higher than that in rural residents(4.5%, 9/198), the difference was statistically significant (χ(2)=11.715,P=0.001). The risk factors for commercial sex behaviors included lack of family and social support, aged 50-59 years, living in urban area, higher income and being male. The risk factors for using no condom included living in rural area, lower education level, lack of family and social support and higher income.

CONCLUSIONS:

Risk sex behaviors are still prevalent in HIV infected people aged >50 years, which exacerbated HIV transmission. Further efforts should be focused on the education about AIDS prevention and control and promoting protected sexual behaviors. Additional effort should be done to improve the family and social support for HIV infected people aged >50 years. Moreover, comprehensive intervention for low-paid female sex workers also needs to be strengthened.

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By:  Zhai J1, Niu J2, Song LJ2, Mei JY2, Xiao MY2, Luo HB2, Ma YL2, Zhang JM3, Li WH4, Yang QW5, Jia MH2.

• 1Kunming Medical University, Kunming 650000, China.
• 2AIDS/STD Department, Yunnan Provincial Center for Disease Control and Prevention, Kunming 650022, China.
• 3Jianshui County Center for Disease Control and Prevention, Jianshui 654300, China.
• 4Gejiu County Center for Disease Control and Prevention, Gejiu 661000, China.
• 5Mengzi County Center for Disease Control and Prevention, Mengzi 661100, China. 
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Mar 10;37(3):371-4. doi: 10.3760/cma.j.issn.0254-6450.2016.03.016.

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Poor Awareness of Syphilis Prevention & Treatment Knowledge among Six Different Populations in South China

BACKGROUND:

China is facing an emerging epidemic of syphilis, and the cities in south China are most affected. Knowledge is a key factor in the prevention of syphilis infection, however, little is reported about how much people know about syphilis. This study was aimed at assessing peoples' awareness status in a city located in south China.

METHODS:

Six populations were recruited for this study, including urban residents, factory workers, college students, pregnant women, female sex workers (FSWs), and men who have sex with men (MSM). A questionnaire designed by the National Center for Disease Control and Prevention was used to assess participants' awareness of syphilis knowledge. About 5 % of participants were randomly selected to conduct a telephone survey for confirming the validity of fieldwork.

RESULTS:

The study recruited 3470 participants, and 61.2 % of participants were assigned to the awareness group. College students had the smallest percentage of awareness at 51.7 % (371/718), followed by FSWs at 53.9 % (200/371), factory workers at 56.0 % (381/679), urban residents at 65.4 % (435/665), pregnant women at 66.0 % (451/683), and MSM at 81.1 % (287/354). Multivariate logistic regression analysis showed that MSM and FSWs-but not factory workers and pregnant women-had more awareness of syphilis knowledge when comparing with urban residents; however, college students presented less awareness of syphilis knowledge than urban residents. Participants of younger age, of female gender, with lower education levels and without Shenzhen hukou possessed less awareness of syphilis knowledge than those of older age, of male gender, with higher education levels and with Shenzhen hukou respectively.

CONCLUSIONS:

The percentages of awareness on syphilis knowledge found in this study are far from the benchmark set in the national 10-year plan. Tailored interventions for different subgroups to increase syphilis awareness are urgently warranted.

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

By:  Wu X1, Hong F2, Lan L1, Zhang C1, Feng T1, Yang Y1.

• 1Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China.
• 2Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China. hfc0755@sina.com. 
• BMC Public Health. 2016 Mar 28;16(1):287. doi: 10.1186/s12889-016-2966-4.

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Factors Associated with High-Risk Behaviors among People Newly Diagnosed with HIV Through Heterosexual Contact Before & After Diagnosis in Some Areas in Henan Province

OBJECTIVE:

To understand the factors associated with high risk behaviors among people newly diagnosed to be infected with HIV through heterosexual contact before and after diagnoses in some areas in Henan province, and evaluate the risk of secondary transmission.

METHODS:

A face to face interview was conducted among people infected with HIV through heterosexual contact by using self-designed questionnaires during January-May in 2015.

RESULTS:

Among 361 HIV infected persons, the proportions of those with commercial heterosexual behaviors or sex with irregular sex partners decreased from 77.3%(279/361) and 28.5%(103/361) before diagnosis to 13.6% (49/361) and 2.5%(9/361) after diagnosis, the difference was significant (χ(2)=16.66,P<0.001;χ(2)= 4.80,P=0.03). The subjects surveyed always had more commercial heterosexual behaviors in Henan, Guangdong and Zhejiang provinces before and after diagnosis. After HIV infection confirmation, the condom use rates were 51.0%(25/49) for commercial heterosexual behaviors, 88.5% (184/208) for sex with regular partners and 88.9%(8/9) for sex with irregular partners, respectively. Multivariate logistic regression analysis indicated that risk behaviors associated with HIV transmission included commercial sexual behaviors, previous HIV detection and age of 35 years or older.

CONCLUSIONS:

Extramarital heterosexual behavior has posed serious challenge to the prevention and control of HIV spread. It is necessary to inform the HIV test results, improve the intervention and promote condom use in people with history of commercial sex and people aged ≥35 years.

Purchase full article [Article in Chinese] at:   http://goo.gl/jj3npC

By:  Fan PY1, Bai YJ2, Yang WJ1, Li N1, Sun DY1, Zhu Q1, Wang Z1.

• 1Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
• 2Zhoukou Prefecture Centre for Disease Control and Prevention, Zhoukou 466000, China.
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Mar 10;37(3):367-70. doi: 10.3760/cma.j.issn.0254-6450.2016.03.015. 

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Estimating HIV Incidence among Key Affected Populations in China from Serial Cross-Sectional Surveys in 2010–2014

Introduction

HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China.

Methods

Serial cross-sectional surveys were conducted among KAPs from 2010 to 2014. Trends in HIV prevalence were assessed by the Cochran-Armitage test, adjusted by risk group. HIV incidence was estimated from a mathematical model that describes the relationship between changes in HIV incidence with HIV prevalence and mortality.

Results

The crude HIV prevalence for the survey samples remained stable at 1.1 to 1.2% from 2010 to 2014. Among drug users (DUs), HIV prevalence declined from 4.48 to 3.29% (p<0.0001), and among men who have sex with men (MSM), HIV prevalence increased from 5.73 to 7.75% (p<0.0001). Changes in HIV prevalence among female sex workers (FSWs) and male patients of sexually transmitted disease clinics were more modest but remained statistically significant (all p<0.0001). The MSM population had the highest incidence estimates at 0.74% in 2011, 0.59% in 2012, 0.57% in 2013 and 0.53% in 2014. Estimates of the annual incidence for DUs and FSWs were very low and may not be reliable.

Conclusions

Serial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic.

Below:  Study period from 2010 to 2014. DUs=drug users, FSW=female sex workers, MSM=men who have sex with men, STD=male patients of sexually transmitted disease clinics, PRG=pregnant women, DRV=long-distance truck drivers, YST=young (college-age) students, MOP=male mobile population (migrant workers).

Below:  Geographical distribution of HIV prevalence among drug users (DU), female sex workers (FSW), men who have sex with men (MSM) and male patients of sexually transmitted disease clinics (STD) in 2014.

Below:  HIV incidence among key populations from 2011 to 2014. DUs=drug users, FSW=female sex workers, MSM=men who have sex with men, STD=male patients of sexually transmitted disease clinics.

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

By:  Yan Cui,1 Wei Guo,1 Dongmin Li,1 Liyan Wang,1 Cynthia X Shi,2 Ron Brookmeyer,3 Roger Detels,4 Lin Ge,1 Zhengwei Ding,1 and Zunyou Wu§,5

¹Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

²Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

³Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA

⁴Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA

⁵National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

§Corresponding author: Zunyou Wu, National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China. Tel: +8610 58900901. Fax: +8610 58900900. 

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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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