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.

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

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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HIV Prevalence & Risk Factors among Left-Behind Women in High HIV Epidemic Rural Areas of Yunnan Province

OBJECTIVE:

To understand the status of HIV infection and risk factors among those left-behind women (LBW) in high HIV epidemic rural areas.

METHODS:

A cross-sectional investigation was conducted between March and May, 2015 in Dehong and Lincang prefectures, Yunnan province, where HIV appeared highly epidemic. Probability Proportion to Size (PPS) sampling method was used, and 500 cases were involved and tested for HIV antibody.

RESULTS:

The total rate of HIV infection among LBW was 8.2% (41/500). The rate of HIV infection among LBWs whose husbands were on medication was 22.7% (30/132). Data from Multi-factor logistic regression analysis showed that the risk factors of HIV infection were: being minorities, education background lower than junior high school, widowed, living in Lincang prefecture, husband infected with HIV but did not consistently use condoms,etc. The rate of HIV infection among other LBWs was 2.8% (10/363). Data from Multi-factor logistic regression analysis showed that the risk factors of HIV infection would include: aged between 30-40 years, being minorities, education background lower than junior high school, divorced, living in Dehong prefecture, having had multiple-sex partners, husband coming home less than once a year,etc. The rate of HIV infection among drug users whose husbands did not take HIV medication was 20.0% (1/5).

CONCLUSION:

HIV prevalence among LBWs in highly HIV epidemic areas was high, and the major risk factors related to their husbands were: being drug users or with HIV infected. Further effort should be made on consistently use of anti-HIV drugs and prevention of inter-marital sexual transmission. Comprehensive intervention should be carried out for LBWs who were having lower education background, being minority and having multiple-sex partners.

Purchase full article [Article in Chinese] at:  http://goo.gl/o8w1q7

By:  Zhang ZY1, Xiao MY2, Niu J2, Li XH2, Song LJ2, Mei JY2, Luo HB2, Jia MH2.

• 1School of Public Health, Kunming Medical University, Kunming, 650500, China.
• 2Center for AIDS/STDs Prevention Control, Yunnan Provincial Center for Disease Control and Prevention, Kunming, 650022, China. 
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Feb 10;37(2):192-6. doi: 10.3760/cma.j.issn.0254-6450.2016.02.008.

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HIV-infected Female Sex Workers' High Risk Behavior and Attitude Changes in Kaiyuan City, Yunnan Province, China

To investigate the attitude and sexual behavior status and change among HIV positive female workers in entertainment sites in Kaiyuan city, Yunnan province, China. The key information should be applied in the integrated intervention program in future.

A cohort survey among HIV positive female workers was conducted during 12 months, between 2010 and 2012. All the risk sexual behavior and attitude were collected for assessment for the potential secondary transmission to sexual partners.

Of 99 HIV positive women who sell sex in Kaiyuan city, 99 participated in the survey at baseline, 80, 80, 75, and 75 at 3-, 6-, 9-, and 12-month follow-ups. The percentage of participants who reported consistently used condoms in the last one month ranged between 94.5% and 95.5%. The client volume in the last one month, income per sex and age group were significant related with non-insistent condom use with their clients.

It was suggested that integrated intervention program package should include 100 percent condom use promotion for the HIV positive FSW with all sexual partners, and also, include socially support involved...

Recent epidemic reports from China suggest that new HIV transmission is increasingly driven by sexual transmission, which show that 46.5% of all people living with HIV are thought to have contracted HIV. This national trend of this reflected in southern Yunnan province, where the early years of the HIV epidemic was dominated by injection drug use due to its proximity to the heroin producing Golden Triangle in Southeast Asia. In contrast to 1989 when all reported cases were attributed to injection drug use, by 2007, 47.4% were attributed by unprotected sex. Though estimates of HIV prevalence among Yunnan FSWs remain relatively low at 2.0%, alarmingly, high rates have been reported among sub-groups across the province including street-based FSWs (18.2%) and drug-using FSWs (36.7%). Female sex workers therefore remain a priority target for prevention activities in Yunnan in light of their own vulnerability to infection and their potential role in HIV transmission to the ‘general population’ through sex with their male clients.

Kaiyuan city is located in Honghe, a largely rural prefecture located in central Yunnan province. Its proximity to a major trade and transit corridor between China and Southeast Asia has brought about rapid economic development to the area since the 1990’s, but along with it a vibrant heroin trafficking trade appeared as well. The result caused heroin use popular as well as the blossoming of a local commercial sex industry, both of which have had profound impacts on HIV/AIDS transmission. It is estimated that more than 1 000 FSWs are working in the downtown area of Kaiyuan, which has a population of roughly 300 000. Due to the prevalence of drug use and commercial sex related behaviors, the ‘twin epidemics’ in Kaiyuan led to it becoming one of the most severely impact cities in the country...

  

Full article at: http://goo.gl/bZX0HL

By: Ding GW1, Hsi JH1, Liu HX1, Su YY1, Wang JJ1, Bai J2, Wang GX2, Wang HB3, Dong RL4, Wang N1.

• 1National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
• 2Kaiyuan City Center for Disease Control and Prevention, Kaiyuan 661600, Yunnan, China.
• 3Chinese Center for Disease Control and Prevention, Beijing 100050, China.
• 4Shenzhen International Travel Healthcare Center, Shenzhen 518033, Guangdong, China.  

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High Prevalence of HIV & Syphilis & Associated Factors among Low-Fee Female Sex Workers in Mainland China: A Cross-Sectional Study

The prevalence of HIV and syphilis among middle and high-fee female sex workers (FSWs) has been widely reported but little is known among low-fee FSWs. This study aims to determine the prevalence and associated factors of HIV and syphilis among low-fee FSWs in China.

A cross-sectional study design was used. A convenience sample of low-fee FSWs was recruited from venues by outreach workers in 12 cities. Structured questionnaire interviews and blood sampling for HIV and syphilis were carried out. Univariate and multivariate logistic regression were used for assessing potential associated factors.

This study enrolled 781 low-fee FSWs. There were 37 (4.7%) HIV positive participants and 117 (15.0%) participants were infected with syphilis. Final multivariate analysis identified five factors associated with HIV infection: older age, local household registration, employed in Yunnan province, soliciting in self-rented rooms and "market day" buildings, injection drug use in the past 6 months; and four factors associated with syphilis infection: older age, employed in Yunnan province, soliciting in self-rented rooms and "market day" buildings, and no consistent condom use with clients in the past 30 days.

A high prevalence of HIV and syphilis were found among low-fee FSWs. Those soliciting in self-rented rooms and "market day" buildings with the lowest income, and injection drug users (IDUs) in this population should take priority in further intervention strategies.

Table 1

Demographic characteristics, work related information and HIV-related behaviors among low-fee female sex workers in 12 cities in China, 2012-2013

Variables	N	%
Demographic characteristics
Age (years)a
≤40	460	58.9
>40	321	41.1
Marital status
Married/cohabiting	581	74.4
Single	200	25.6
Years of schooling
>5	230	29.4
≤5	551	70.6
Ethnicity
Han ethnicity	473	60.6
Minorities	308	39.4
Household registration
Non-local	505	64.7
Local	276	35.3
Province of employment
Guangxi	310	39.7
Hunan	246	31.5
Yunnan	225	28.8
Work-related information
Had ever changed work location
Yes	98	12.6
No	681	87.4
Length of being a FSW
<6 months	249	31.9
7-12 months	83	10.6
13-24 months	148	19.0
>24 months	301	38.5
Soliciting venues
Small hair/beauty salons	162	20.7
Small guesthouses	136	17.4
On streets	168	21.5
Self -rented rooms	238	30.5
“Market day” buildings	77	9.9
Price charged for vaginal sex
20-50	633	81.0
≤20	148	19.0
Estimated average age of clients
<50	422	54.0
≥50	359	46.0
HIV-related behaviors
Consistent condom use with clients in the past 30 days
Yes	381	48.8
No	400	51.2
Injection drug use in the past 6 months
Yes	30	3.9
No	751	96.1
Received HIV testing in the past year
Yes	309	39.6
No	472	60.4

aThe cut-off point of 40 years old was set to distinguish older FSWs from younger FSWs [18,19].

Full article at: http://goo.gl/N1Nu4q

By: Zhou C, Rou K, Dong WM, Wang Y, Dong W, Zhou Y, Chen X, Jia M, Liu W, Zheng J, Ma Y, Li Y, Wu Z1; China National HIV Prevention Study Group.

1National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing, Changping District 102206

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Vaginal Douching & Association with Sexually Transmitted Infections among Female Sex Workers in a Prefecture of Yunnan Province, China

Vaginal douching is a common practice and has been hypothesised to increase a woman's risk for human immunodeficiency virus and sexually transmitted infections. Our objective was to assess the prevalence of douching and association with sexually transmitted infections, genital symptoms and human immunodeficiency virus/sexually transmitted infections knowledge among female sex workers.

We conducted a cross-sectional study of 837 female sex workers with interviews and laboratory tests for human immunodeficiency virus/sexually transmitted infections in a prefecture of Yunnan Province in southern China.

• Vaginal douching was reported by 84% of the women. 
• We found a higher prevalence of vaginal douching practice among female sex workers of Han ethnicity, and who were single or cohabitating. 
• Douching was also significantly more common among more educated female sex workers and those with greater knowledge about human immunodeficiency virus/sexually transmitted infections and with female sex workers who experienced clinical symptoms in previous 12 months. 
• Douching was linked to higher risks of human immunodeficiency virus and herpes simplex virus type 2 infections after adjusting for confounding factors.

Medical professional and public health workers should correct women's misconception about the effectiveness of douching and discourage women from douching through educational activities. More prospective studies among female sex workers are urgently required to identify the relationship between vaginal douching and human immunodeficiency virus/sexually transmitted infections infection.

Via: http://goo.gl/VOgNjj  Purchase full article at: http://goo.gl/lfMXcD

By: Luo L1, Xu JJ2, Wang GX3, Ding GW4, Wang N4, Wang HB5.

• 1Chinese Center for Disease Control and Prevention, Beijing, PR China.
• 2Key Laboratory of Immunology of AIDS, Ministry of Health, First Affiliated Hospital, China Medical University, Shenyang, PR China.
• 3Kaiyuan Center for Disease Control and Prevention, Yunnan, PR China.
• 4National Center for AIDS/STD Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, PR China.
• 5Peking University Clinical Research Institute, Beijing, PR China 

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Exploitation, Violence, and Suicide Risk Among Child and Adolescent Survivors of Human Trafficking in the Greater Mekong Subregion

Human trafficking and exploitation of children have profound health consequences. To our knowledge, this study represents the largest survey on the health of child and adolescent survivors of human trafficking.

To describe experiences of abuse and exploitation, mental health outcomes, and suicidal behavior among children and adolescents in posttrafficking services. We also examine how exposures to violence, exploitation, and abuse affect the mental health and suicidal behavior of trafficked children.

A survey was conducted with 387 children and adolescents aged 10 to 17 years in posttrafficking services in Cambodia, Thailand, or Vietnam, which along with Laos, Myanmar, and Yunnan Province, China, compose the Greater Mekong Subregion. Participants were interviewed within 2 weeks of entering services from October 2011 through May 2013.

Depression, posttraumatic stress disorder, anxiety, suicidal ideation, self-injury, and suicide attempts.

Among the 387 children and adolescent study participants, most (82%) were female. 

• 12% had tried to harm or kill themselves in the month before the interview. 
• 56% screened positive for depression, 33% for an anxiety disorder, and 26% for posttraumatic stress disorder. 
• Abuse at home was reported by 20%. 
• Physical violence while trafficked was reported by 41% of boys and 19% of girls. 
• 23% of girls and 1 boy reported sexual violence. 
• Mental health symptoms were strongly associated with recent self-harm and suicide attempts. 
• Severe physical violence was associated with depression, and suicidal ideation. 
• Sexual violence while trafficked was associated with depression and suicidal ideation.

Children and adolescents in posttrafficking care showed high symptom levels of depression, anxiety, and posttraumatic stress disorder, which are strongly associated with self-harm or suicidal behaviors. Mental health screening and reintegration risk assessments are critical components of posttrafficking services, especially in planning for family reunification and other social integration options.

Via:  http://ht.ly/SxM77 Purchase full article at: http://goo.gl/420OmW

By: Kiss L1, Yun K2, Pocock N1, Zimmerman C3.

• 1Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England.
• 2PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
• 3Reader in Gender Violence and Health, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England.

Illicit Heroin and Methamphetamine Use among Methadone Maintenance Treatment Patients in Dehong Prefecture of Yunnan Province, China

Read at: http://goo.gl/aY7aaW HT @FudanUniversity

A total of 2,121 were eligible and participated in the study. Among them, 220 (10.4%) were only positive for morphine, 12.9% were only positive for MAMP, and 196 (9.2%) were positive for both morphine and MAMP. Compared with neither use of heroin nor MAMP during MMT, heroin use (not using MAMP) was associated with ethnicity, shorter duration of MMT, lower dose of methadone, and having had no more than two sex partners in the past year; MAMP use (not using heroin) was associated with ethnicity, longer duration of MMT, higher dose of methadone and being aged <30 years (vs. ≥50 years); use of both heroin and MAMP was associated with being Dai minority (vs. Han), a marital status of divorced or widowed, having used drugs for ≥10 years and shorter duration of MMT.

These findings indicate the complexity in the treatment of heroin users and underscore the importance in prescribing appropriate methadone dosages in order to reduce both heroin and MAMP use.