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Journal ArticleDOI

Evolution of China's response to HIV/AIDS

TL;DR: Four factors have driven China's response to the HIV/AIDS pandemic: existing government structures and networks of relationships, increasing scientific information, external influences that underscored the potential consequences of an HIV/ AIDS pandemic, accelerated strategic planning, and increasing political commitment at the highest levels.
About: This article is published in The Lancet.The article was published on 2007-02-24 and is currently open access. It has received 428 citations till now. The article focuses on the topics: HIV/AIDS in China & Acquired immunodeficiency syndrome (AIDS).
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Journal ArticleDOI
TL;DR: Marked improvement in tuberculosis treatment, driven by a major shift in treatment from hospitals to the public health centres (that implemented the DOTS strategy) was largely responsible for this epidemiological effect.

407 citations

Journal ArticleDOI
01 Oct 2008-Nature
TL;DR: HIV has advanced from high-risk groups such as intravenous drug users to some in the general population, according to comprehensive new data from the south of China.
Abstract: HIV has advanced from high-risk groups such as intravenous drug users to some in the general population, according to comprehensive new data from the south of China. What needs to be done to halt its spread?

252 citations

Journal ArticleDOI
TL;DR: Wang et al. as mentioned in this paper used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and 2009.
Abstract: Summary Background Overall HIV mortality rates in China have not been reported. In this analysis we assess overall mortality in treatment-eligible adults with HIV and attempt to identify risk factors for HIV-related mortality. Methods We used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and 2009. Mortality rates were calculated in terms of person-years, with risk factors determined by Cox proportional hazard regression. Treatment coverage was calculated as the proportion of time that patients who were eligible for treatment received treatment, with risk factors for not receiving treatment identified by use of logistic regression. Findings Of 323 252 people reported as having HIV in China by the end of 2009, 145 484 (45%) were identified as treatment-eligible and included in this analysis. Median CD4 count was 201 cells per μL (IQR 71–315) at HIV diagnosis and 194 cells per μL (73–293) when first declared eligible for treatment. Overall mortality decreased from 39·3 per 100 person-years in 2002 to 14·2 per 100 person-years in 2009, with treatment coverage concomitantly increasing from almost zero to 63·4%. By 2009, mortality was higher and treatment coverage lower in injecting drug users (15·9 deaths per 100 person-years; 42·7% coverage) and those infected sexually (17·5 deaths per 100 person-years; 61·7% coverage), compared with those infected through plasma donation or blood transfusion (6·7 deaths per 100 person-years; 80·2% coverage). The two strongest risk factors for HIV-related mortality were not receiving highly active antiretroviral therapy (adjusted hazard ratio 4·35, 95% CI 4·10–4·62) and having a CD4 count of less than 50 cells per μL when first declared eligible for treatment (7·92, 7·33–8.57). Interpretation An urgent need exists for earlier HIV diagnosis and better access to treatment for injecting drug users and patients infected with HIV sexually, especially before they become severely immunosuppressed. Funding The National Centre for AIDS/STD Control and Prevention of the Chinese Centre for Disease Control and Prevention.

225 citations

Journal ArticleDOI
TL;DR: The present study presents a novel and scalable approach called “informed consent” that aims to provide real-time information about the Administrator’s decision to vaccinate against HIV/AIDS in patients at risk of infection.

194 citations

Journal ArticleDOI
08 Oct 2012-PLOS ONE
TL;DR: This study provides the first comprehensive baseline data on the diversity and characteristics of HIV/AIDS epidemic in China, reflecting unique region- and risk group-specific transmission dynamics.
Abstract: Background China is experiencing a dynamic HIV/AIDS epidemic. While serology based surveillance systems have reported the spread of HIV/AIDS, detailed tracking of its transmission in populations and regions is not possible without mapping it at the molecular level. We therefore conducted a nationwide molecular epidemiology survey across the country. Methods HIV-1 genotypes were determined from 1,408 HIV-positive persons newly diagnosed in 2006. The prevalence of each genotype was estimated by weighting the genotype’s prevalence from each province- and risk-specific subpopulation with the number of reported cases in the corresponding subgroups in that year. Results CRF07_BC (35.5%), CRF01_AE (27.6%), CRF08_BC (20.1%), and subtype B' (9.6%) were the four main HIV-1 strains in China. CRF07_BC and CRF08_BC were the primary drivers of infection among injecting drug users in northeastern and southeastern China, respectively, and subtype B' remained dominant among former plasma donors in central China. In contrast, all four strains occurred in significant proportions among heterosexuals nationwide, pointing to an expansion of the HIV-1 epidemic from high-risk populations into the general population. CRF01_AE also replaced subtype B as the principal driver of infection among men-who-have-sex-with-men. Conclusions Our study provides the first comprehensive baseline data on the diversity and characteristics of HIV/AIDS epidemic in China, reflecting unique region- and risk group-specific transmission dynamics. The results provide information critical for designing effective prevention measures against HIV transmission.

194 citations


Cites background from "Evolution of China's response to HI..."

  • ...6% in 2006, in accordance with national policies that strictly regulated blood donations since the late 1990s [36]....

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References
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Journal ArticleDOI

1,651 citations

Journal ArticleDOI
TL;DR: AIDS stigma affects the well-being of PWAs and influences their personal choices about disclosing their serostatus to others, and may continue to have an impact as policies providing special protection to people with HIV face renewed scrutiny.
Abstract: This article briefly reviews current knowledge about AIDS-related stigma, defined as prejudice, discounting, discrediting, and discrimination directed at people perceived to have AIDS or HIV, and the individuals, groups, and communities with which they are associated. AIDS stigma has been manifested in discrimination, violence, and personal rejection of people with AIDS (PWAs). Whereas the characteristics of AIDS as an illness probably make some degree of stigma inevitable, AIDS has also been used as a symbol for expressing negative attitudes toward groups disproportionately affected by the epidemic, especially gay men and injecting drug users (IDUs). AIDS stigma affects the well-being of PWAs and influences their personal choices about disclosing their serostatus to others. It also affects PWAs' loved ones and their caregivers, both volunteers and professionals. Stigma has hindered society's response to the epidemic, and may continue to have an impact as policies providing special protection to people wi...

650 citations

Journal ArticleDOI
Lisa A. Marsch1
TL;DR: The effectiveness of methadone maintenance treatment is evident among opiate-dependent individuals across a variety of contexts, cultural and ethnic groups, and study designs, and the treatment is most apparent in its ability to reduce drug-related criminal behaviors.
Abstract: Aims. To provide empirically based evaluation data regarding the efficacy of psychopharmacological interventions in opiate substance abuse, the present study employed meta-analytic statistical procedures to determine the effectiveness of methadone hydrochloride as a pharmacotherapeutic agent . Design. Empirical research findings from 11 studies investigating the effect of methadone maintenance treatment (MMT) on illicit opiate use, and eight and 24 studies investigating the effect of MMT on HIV risk behaviors and criminal activities, respectively, by individuals in such treatment were addressed . Findings. Results demonstrate a consistent, statistically significant relationship between MMT and the reduction of illicit opiate use, HIV risk behaviors and drug and property-related criminal behaviors. The effectiveness of MMT is most apparent in its ability to reduce drug-related criminal behaviors. MMT had a moderate effect in reducing illicit opiate use and drug and property-related criminal behaviors, and a small to moderate effect in reducing HIV risk behaviors . Conclusions. Results clarify discrepancies in the literature and are useful in predicting the outcomes of individuals in treatment. The treatment's effectiveness is evident among opiate-dependent individuals across a variety of contexts, cultural and ethnic groups, and study designs.

551 citations

Journal ArticleDOI
TL;DR: For more than two decades, HIV-related stigmatization, discrimination and denial have characterized the pandemic and presented a major challenge to the effectiveness of prevention, care and treatment programmes.
Abstract: For more than two decades, HIV-related stigmatization, discrimination and denial have characterized the pandemic and presented a major challenge to the effectiveness of prevention, care and treatment programmes. Much of the societal and individual reaction towards people with HIV/AIDS may arise from stigma towards those most affected, where fear and blame are assigned and from which societal, political and behavioural responses are derived. Stigmatization and discrimination are reported to occur in a variety of forms–from societal level responses such as coercive government policies and laws, to apathy and denial of the HIV epidemic. At the individual level, the internalization of these societal responses may result in an individual's self-exclusion from information, treatment and care. Stigmatization and discrimination are explored through sociocultural understandings of illness and disease transmission and its manifestations at societal and invidividual level. Contexts of discrimination are bri...

232 citations

Book
13 Mar 1992
TL;DR: The authors gathered together an international group of practitioners who argue persuasively about the paramount importance of harm reduction strategies rather than total abstention in the fight against drugs, and they concluded that "harm reduction is more important than total abstinence".
Abstract: This book gathers together an international group of practitioners who argue persuasively about the paramount importance of harm reduction strategies rather than total abstention in the fight against drugs.

199 citations