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Unsafe Sex and STI Prevalence Among HIV-Infected Adults in Guangzhou, China: Opportunities to Deamplify Sexual HIV Transmission

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Abstract

This project examined sexual behavior and STI prevalence among HIV-infected individuals in South China. Adult HIV-infected outpatients in Guangzhou, Guangdong Province, China completed a self-administered survey about behaviors and antiretroviral treatment. Participants were screened for syphilis, gonorrhea, and chlamydia. Univariate and multivariate relationships with any STI were calculated using logistic regression. 810 HIV-infected individuals participated and 3 refused. 52.5 % (n = 415) of individuals reported having sex in the past 3 months, among whom 26.4 % (n = 111) reported inconsistent condom use. 10.4 % (n = 84) of all individuals had at least one sexually transmitted infection (STI). HIV-infected individuals not on antiretroviral treatment had an increased STI risk (aOR 2.5, 95 % CI: 1.4–4.5, P = 0.002). Unsafe sex was markedly reduced among HIV-infected individuals on treatment, possibly a reflection of integrated ART initiation counseling. Improved STI services among HIVinfected individuals are urgently needed to deamplify sexual HIV transmission.

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References

  1. Wasserheit JN. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis. 1992;19:61–77.

    PubMed  CAS  Google Scholar 

  2. Ward H, Ronn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5:305–10.

    Article  PubMed  Google Scholar 

  3. Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997;349:1868–73.

    Article  PubMed  CAS  Google Scholar 

  4. Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis. Sex Transm Dis. 2008;35:946–59.

    Article  PubMed  Google Scholar 

  5. Kalichman SC, Pellowski J, Turner C. Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention. Sex Transm Infect. 2011;87:183–90.

    Article  PubMed  Google Scholar 

  6. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.

    Article  PubMed  CAS  Google Scholar 

  7. Sheth PM, Kovacs C, Kemal KS, et al. Persistent HIV RNA shedding in semen despite effective antiretroviral therapy. AIDS. 2009;23:2050–4.

    Article  PubMed  CAS  Google Scholar 

  8. Scheer S, Chu PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet. 2001;357:432–5.

    Article  PubMed  CAS  Google Scholar 

  9. Stolte IG, Dukers NH, de Wit JB, Fennema JS, Coutinho RA. Increase in sexually transmitted infections among homosexual men in Amsterdam in relation to HAART. Sex Transm Infect. 2001;77:184–6.

    Article  PubMed  CAS  Google Scholar 

  10. Venkatesh KK, de Bruyn G, Lurie MN, et al. Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics. AIDS. 2010;24:2687–96.

    Article  PubMed  Google Scholar 

  11. Bunnell R, Ekwaru JP, Solberg P, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS. 2006;20:85–92.

    Article  PubMed  Google Scholar 

  12. Marcellin F, Bonono CR, Blanche J, Carrieri MP, Spire B, Koulla-Shiro S. Higher risk of unsafe sex and impaired quality of life among patients not receiving antiretroviral therapy in Cameroon: results from the EVAL survey (ANRS 12–116). AIDS. 2010;24:S17–25.

    Article  PubMed  Google Scholar 

  13. Luchters S, Sarna A, Geibel S, et al. Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: a prospective cohort. AIDS Patient Care STDS. 2008;22:587–94.

    Article  PubMed  Google Scholar 

  14. Lu L, Jia M, Ma Y, et al. The changing face of HIV in China. Nature. 2008;455:609–11.

    Article  PubMed  CAS  Google Scholar 

  15. Tucker JD, Cohen MS. China’s syphilis epidemic: epidemiology, proximate determinants of spread, and control responses. Curr Opin Infect Dis. 2011;24:50–5.

    Article  PubMed  Google Scholar 

  16. Wang N, Wang L, Wu Z, et al. Estimating the number of people living with HIV/AIDS in China: 2003–09. Int J Epidemiol. 2010;39(2):ii21–8.

    Google Scholar 

  17. Zhang F, Haberer JE, Wang Y, et al. The Chinese free antiretroviral treatment program: challenges and responses. AIDS. 2007;21:S143–8.

    Article  PubMed  Google Scholar 

  18. Zhang F, Dou Z, Ma Y, et al. Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study. Lancet Infect Dis. 2011;11(7):516–24.

    Article  PubMed  Google Scholar 

  19. Eisele TP, Mathews C, Chopra M, et al. Changes in risk behavior among HIV-positive patients during their first year of antiretroviral therapy in Cape Town South Africa. AIDS Behav. 2009;13:1097–105.

    Article  PubMed  Google Scholar 

  20. Chinese Health and Family Life Survey. University of Chicago, 1999. (http://popcenter.uchicago.edu/data/chfls.shtml). Accessed 11 Jan 2011.

  21. Cu-Uvin S, DeLong AK, Venkatesh KK, et al. Genital tract HIV-1 RNA shedding among women with below detectable plasma viral load. AIDS. 2010;24:2489–97.

    Article  PubMed  Google Scholar 

  22. China’s mega city: the country’s existing mega cities. 2011. (http://www.telegraph.co.uk/news/worldnews/asia/china/8278325/Chinas-mega-city-the-countrys-existing-mega-cities.html). Accessed 9 Nov 2011.

  23. Zhang F, Haberer JE, Wang Y, et al. The Chinese free antiretroviral treatment program: challenges and responses. AIDS. 2007;21(Suppl 8):S143–8.

    Article  PubMed  Google Scholar 

  24. Dou Z, Chen RY, Xu J, et al. Changing baseline characteristics among patients in the China National Free Antiretroviral Treatment Program, 2002–09. Int J Epidemiol. 2010;39(Suppl 2):ii56–64.

    Article  PubMed  Google Scholar 

  25. Lin P, Wang Y, Li J, et al. HIV/AIDS prevalence and control strategies in Guangdong Province. South China J Prev Med. 2008:1–5.

  26. National Center for AIDS/STD Control and Prevention. Chinese Centre for Disease Control and Prevention. China: National annual report on data information of HIV/AIDS comprehensive prevention and control. Beijing; 2009.

    Google Scholar 

  27. Zhang F, Dou Z, Ma Y, et al. Five-year outcomes of the China National Free Antiretroviral Treatment Program. Ann Intern Med. 2009;151:241–51.

    PubMed  Google Scholar 

  28. He Q, Peng WJ, Zhang JQ, Wang BX, Wang J. Prevalence of unprotected anal intercourse and unprotected vaginal intercourse among HIV-positive men who have sex with men in China: a meta-analysis. Sex Transm Infect. 2011;8:8.

    Google Scholar 

  29. Lee HC, Ko NY, Lee NY, Chang CM, Liu SY, Ko WC. Trends in sexually transmitted diseases and risky behaviors among HIV-infected patients at an outpatient clinic in southern Taiwan. Sex Transm Dis. 2010;37:86–93.

    Article  PubMed  Google Scholar 

  30. Huang Q, Wang, GQ, Xie, JL, et al. Diagnostic results for HBV, HCV and syphilis among 206 HIV-infected individual. Chin J Hainan Med Univ 2011;17.

  31. Zhang X, Wang C, Hengwei W, et al. Risk factors of HIV infection and prevalence of co-infections among men who have sex with men in Beijing, China. AIDS. 2007;21:S53–7.

    Article  PubMed  Google Scholar 

  32. Tan S, Yang ZZ, Xing PQ. HIV and STI among IDU. Chin J Drug Depend. 2003;12.

  33. Liu L, Xu WZ, He ZS, et al. Analysis of STD monitoring results among IDU in Taizhou. Chin J AIDS STD 2007;13.

  34. Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292:224–36.

    Article  PubMed  CAS  Google Scholar 

  35. Miller M, Meyer L, Boufassa F, et al. Sexual behavior changes and protease inhibitor therapy. SEROCO Study Group. AIDS. 2000;14:F33–9.

    Article  PubMed  CAS  Google Scholar 

  36. Landes M, Thorne C, Barlow P, et al. Prevalence of sexually transmitted infections in HIV-1 infected pregnant women in Europe. Eur J Epidemiol. 2007;22:925–36.

    Article  PubMed  Google Scholar 

  37. Sorvillo F, Kovacs A, Kerndt P, Stek A, Muderspach L, Sanchez-Keeland L. Risk factors for trichomoniasis among women with human immunodeficiency virus (HIV) infection at a public clinic in Los Angeles County, California: implications for HIV prevention. Am J Trop Med Hyg. 1998;58:495–500.

    PubMed  CAS  Google Scholar 

  38. Cai Y, Lavely W. China’s missing girls: numerical estimates and effects on population growth. China Rev. 2003;3:13–29.

    Google Scholar 

  39. Tucker JD, Henderson GE, Wang TF, et al. Surplus men, sex work, and the spread of HIV in China. AIDS. 2005;19:539–47.

    Article  PubMed  Google Scholar 

  40. Tucker JD, Yin YP, Wang B, Chen XS, Cohen MS. An expanding syphilis epidemic in China: epidemiology, behavioural risk and control strategies with a focus on low-tier female sex workers and men who have sex with men. Sex Transm Infect. 2011;87:ii16–8.

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Acknowledgments

We would like to thank the nursing staff and Dr. Haolan He at the Guangzhou Municipal No. Eight People’s Hospital infectious disease outpatient clinic, Dr. Xuan Hong, and Dr. Cheng Wang at Guangdong Provincial Center for Skin Diseases and STD Control, and Dr. Bunnell and Dr. Eisele for sharing their questionnaires. This project was supported by the UNC Center for AIDS Research (NIH 5P30AI050410-13), the Doris Duke Charitable Foundation International Medical Student Program, and an International Research Scientist Developmental Award (NIH 1K01TW008200-01A1), and Twelve Fifth Key Research grant from the Ministry of Science and Technology, the People’s Republic of China (NO: 2012ZX10001003-003).

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Authors and Affiliations

  1. Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Xiao B. Wang

  2. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Joseph D. Tucker & Myron S. Cohen

  3. STD Control Department, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China

    Ligang Yang, Heping Zheng & Bin Yang

  4. Division of Treatment and Care, National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China

    Fujie Zhang

  5. Department of Medicine, Number Eight People’s Hospital of Guangzhou, Guangzhou Medical University, Guangzhou, China

    Weiping Cai

Authors
  1. Xiao B. Wang
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  2. Joseph D. Tucker
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  3. Ligang Yang
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  4. Heping Zheng
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  5. Fujie Zhang
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  6. Myron S. Cohen
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  7. Bin Yang
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  8. Weiping Cai
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Corresponding author

Correspondence to Weiping Cai.

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Xiao B. Wang and Joseph D. Tucker contributed equally to this study.

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Wang, X.B., Tucker, J.D., Yang, L. et al. Unsafe Sex and STI Prevalence Among HIV-Infected Adults in Guangzhou, China: Opportunities to Deamplify Sexual HIV Transmission. AIDS Behav 17, 1137–1143 (2013). https://doi.org/10.1007/s10461-012-0322-y

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