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Journal ArticleDOI

HIV prevalence in China: integration of surveillance data and a systematic review.

TL;DR: HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China, and strong associations between HIV prevalence among at-risk populations in each province are recorded, supporting the existence of overlap in risk behaviours and mixing among these populations.
Abstract: Summary Background Asian HIV epidemics are concentrated among particular behavioural groups, but large variations exist in epidemic types, timing, and geographical spread between countries and within countries, especially in China. We aimed to understand the complexity of HIV epidemics in China by systematically analysing prevalence trends by data source, region, population group, and time period. Methods We collected HIV prevalence data from official national sentinel surveillance sites at the provincial level from Jan 1, 1995, to Dec 31, 2010. We also searched PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from Jan 1, 1990, to Dec 31, 2012, for independent studies of HIV prevalence. We integrated both sets of data, and used an intraclass correlation coefficient test to assess the similarity of geographical pattern of HIV disease burden across 31 Chinese provinces in 2010. We investigated prevalence trends (and 95% CIs) to infer corresponding incidence by region, population group, and year. Findings Of 6850 articles identified by the search strategy, 821 studies (384 583 drug users, 52 356 injecting drug users, 186 288 female sex workers, and 87 834 men who have sex with men) met the inclusion criteria. Official surveillance data and findings from independent studies showed a very similar geographical distribution and magnitude of HIV epidemics across China. We noted that HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China. Compared with injecting drug users, HIV prevalence in female sex workers is much lower and has stabilised at low levels in all regions except in the southwest. In 2010, national HIV prevalence was 9·08% (95% CI 8·04–10·52) in injecting drug users and 0·36% (0·12–0·71) in female sex workers, whereas incidence in both populations stabilised at rates of 0·57 (0·43–0·72) and 0·02 (0·01–0·04) per 100 person-years, respectively. By comparison, HIV prevalence in men who have sex with men increased from 1·77% (1·26–2·57) in 2000, to 5·98% (4·43–8·18) in 2010, with a national incidence of 0·98 (0·70–1·25) per 100 person-years in 2010. We recorded strong associations between HIV prevalence among at-risk populations in each province, supporting the existence of overlap in risk behaviours and mixing among these populations. Interpretation HIV epidemics in China remain concentrated in injecting drug users, female sex workers, and men who have sex with men. HIV prevalence is especially high in southwest China. Sex between men has clearly become the main route of HIV transmission. Funding The World Bank Group, the Australian Research Council, the University of New South Wales, and Chinese Center for Disease Control and Prevention.
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Journal ArticleDOI
TL;DR: The highest PAF among men was smoking in all 31 provinces, whereas among women it varied among low fruit intake (14 provinces), hepatitis B virus infection (seven provinces), smoking (six provinces), excess bodyweight (three provinces), and human papilloma virus infection(one province).

148 citations

Journal ArticleDOI
TL;DR: The Tsinghua–Lancet Commission on Healthy Cities in China aimed to characterise, understand, and address urban health challenges in the unique context of China’s rapid and dynamic urban development.

142 citations

Journal ArticleDOI
TL;DR: It is demonstrated that dysbiosis of fecal microbiota might play an active role in HIV-1 infection and new insights may be provided into therapeutics that target the microbiota to attenuate the progression of HIV disease and to reduce the risk of gut-linked disease in patients with human immunodeficiency virus 1.
Abstract: The available evidence suggests that alterations in gut microbiota may be tightly linked to the increase in microbial translocation and systemic inflammation in patients with human immunodeficiency virus 1 (HIV-1) infection. We profiled the fecal microbiota as a proxy of gut microbiota by parallel barcoded 454-pyrosequencing in 67 HIV-1-infected patients (32 receiving highly active antiretroviral therapy [HAART] and 35 HAART naive) and 16 healthy controls from a Chinese population. We showed that α-diversity indices did not differ significantly between the healthy control and HIV-1-infected patients. The ratio of Firmicutes/Bacteroidetes increased significantly in HIV-1-infected patients. Several key bacterial phylotypes, including Prevotella, were prevalent in HIV-1-infected patients; whereas Phascolarctobacterium, Clostridium XIVb, Dialister and Megamonas were significantly correlated with systemic inflammatory cytokines. After short-term, effective HAART, the viral loads of HIV-1 were reduced; however, the diversity and composition of the fecal microbiota were not completely restored. and the dysbiosis remained among HIV-1-infected subjects undergoing HAART. Our detailed analysis demonstrated that dysbiosis of fecal microbiota might play an active role in HIV-1 infection. Thus, new insights may be provided into therapeutics that target the microbiota to attenuate the progression of HIV disease and to reduce the risk of gut-linked disease in HIV-1-infected patients.

132 citations

Journal ArticleDOI
TL;DR: Data from two randomized controlled trials suggests that crowdsourcing contests can increase HIV testing, creating demand for services while engaging communities, and improving HIV surveillance and expanding HIV interventions for Chinese MSM and TG individuals are essential.
Abstract: Despite global efforts to control HIV among key populations, new infections among men who have sex with men (MSM) and transgender (TG) individuals are still increasing. The increasing HIV epidemic among MSM/TG in China indicates that more effective services are urgently needed. However, policymakers and program managers must have a clear understanding of MSM/TG sexual health in China to improve service delivery. To meet this need, we undertook a scoping review to summarize HIV epidemiology and responses among MSM and TG individuals in China. We searched MEDLINE, EMBASE and the Cochrane Library for recent studies on MSM/TG HIV epidemiology and responses. We also included supplemental articles, grey literature, government reports, policy documents, and best practice guidelines. Overall, HIV prevalence among Chinese MSM was approximately 8 % in 2015 with a higher prevalence observed in Southwest China. TG are not captured in national HIV, STD, or other sexual health surveillance systems. There is limited data sharing between the public health authorities and community-based organizations (CBOs). Like other low and middle income countries, China is challenged by low rates of HIV testing, linkage, and retention. Several pilot interventions have been shown to be effective to increase HIV testing among MSM and TG individuals, but have not been widely scaled up. Data from two randomized controlled trials suggests that crowdsourcing contests can increase HIV testing, creating demand for services while engaging communities. Improving HIV surveillance and expanding HIV interventions for Chinese MSM and TG individuals are essential. Further implementation research is needed to ensure high-quality HIV services for MSM and TG individuals in China.

90 citations


Cites background from "HIV prevalence in China: integratio..."

  • ...0 % in 2010 [16], and it has gradually increased to 8....

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  • ...Based on a systematic review, HIV prevalence is increasing across all regions of China, particularly in the southwest region, made up of five provinces [16]....

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Journal ArticleDOI
TL;DR: Investigation of the prevalence and factors associated with suicidal ideation among HIV-positive men who have sex with men (MSM) in Anhui, China indicated that suicidal Ideation was common among HIV, and targeting of these potential risk factors could be an effective approach to reduce the suicide risk among this high-risk subgroup.
Abstract: The aim of this study was to investigate the prevalence and factors associated with suicidal ideation among HIV-positive men who have sex with men (MSM) in Anhui, China A cross-sectional study was

66 citations


Cites background from "HIV prevalence in China: integratio..."

  • ...4% of all notified HIV cases in China.(4,6)...

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  • ...98% in 2011.(4) It is estimated that 12....

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References
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Journal ArticleDOI
TL;DR: Bernard Rosner's FUNDAMENTALS of BIOSTATISTICS is a practical introduction to the methods, techniques, and computation of statistics with human subjects that prepares students for their future courses and careers.
Abstract: Bernard Rosner's FUNDAMENTALS OF BIOSTATISTICS is a practical introduction to the methods, techniques, and computation of statistics with human subjects. It prepares students for their future courses and careers by introducing the statistical methods most often used in medical literature. Rosner minimizes the amount of mathematical formulation (algebra-based) while still giving complete explanations of all the important concepts. As in previous editions, a major strength of this book is that every new concept is developed systematically through completely worked out examples from current medical research problems.

4,624 citations

Book
01 Jan 1982
TL;DR: Bernard Rosner's "Fundamentals of BIOSTATISTICS" as mentioned in this paper is a practical introduction to the methods, techniques, and computation of statistics with human subjects.
Abstract: Bernard Rosner's FUNDAMENTALS OF BIOSTATISTICS is a practical introduction to the methods, techniques, and computation of statistics with human subjects. It prepares students for their future courses and careers by introducing the statistical methods most often used in medical literature. Rosner minimizes the amount of mathematical formulation (algebra-based) while still giving complete explanations of all the important concepts. As in previous editions, a major strength of this book is that every new concept is developed systematically through completely worked out examples from current medical research problems.

4,438 citations

Journal ArticleDOI
TL;DR: It is shown that the high probability of transmission per act through receptive anal intercourse has a central role in explaining the disproportionate disease burden in MSM and prevention strategies that lower biological transmission and acquisition risks offer promise.

1,369 citations

Journal ArticleDOI
TL;DR: A strategic investment framework is proposed that is intended to support better management of national and international HIV/AIDS responses than exists with the present system and would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020.

478 citations

Journal ArticleDOI
TL;DR: HIV continues to spread among MSM on a global level and current prevention efforts have been unable to contain or reduce HIV transmission in this population.
Abstract: Purpose of review In the last few years, there have been reports of new, newly identified and resurging epidemics of HIV infection among men who have sex with men (MSM). This article reviews and summarizes the global epidemic of HIV infection among MSM. Recent findings In the Western world, the increase in notifications of new HIV infections among MSM is continuing. Steep increases in reports of new HIV diagnoses among MSM were also seen in the developed economies of East Asia. In the developing world, epidemiologic studies have now established the presence of MSM populations in Africa, China and Russia and a high HIV prevalence among them. High and increasing HIV prevalence was also reported from South and Southeast Asia, and Latin America and the Caribbean. Summary

260 citations