AIDS and Behavior

, Volume 18, Supplement 1, pp 5–10 | Cite as

Emerging Disparity in HIV/AIDS Disease Progression and Mortality for Men Who Have Sex with Men, Jiangsu Province, China

  • Hongjing Yan
  • Haitao Yang
  • Jianjun Li
  • Chongyi Wei
  • Jinshui Xu
  • Xiaoyan Liu
  • Xiaoqin Xu
  • Willi McFarlandEmail author
Original Paper


Few data exist on HIV disease progression and antiretroviral treatment (ART) impact among men who have sex with men (MSM) in China. Using data from the national case reporting system from 2004 to 2010, we describe changes in CD4 cell count before and after ART initiation, disease progression, and mortality among MSM in Jiangsu province compared with other persons living with HIV/AIDS. Median CD4 cell count among MSM at HIV diagnosis was 432 and decreased rapidly in 12 months to below the level of heterosexuals (slope: MSM −38.0, heterosexuals −15.5, injection drug users [IDU] −8.0, blood donors −10.5). Among those initiating ART, median CD4 cell count among MSM was 157, yet the increase in count was slower than for other groups (slope: MSM 26.9, heterosexuals 31.9, IDU 29.0, blood donors 35.0). Progression to AIDS was faster among MSM than heterosexuals and IDU. For the present, the mortality rate was lower for MSM compared with heterosexuals and blood donors; however, against a backdrop of more recent infection (ie, MSM had younger age, and 93.8 % were diagnosed after 2008), findings suggest a survival rate for MSM that will fall behind other groups. Improved medical and psychosocial supportive care is needed for this stigmatized population lest disparities become greater.


China Gay men Surveillance Disease progression Mortality HIV 



The study was supported by the Jiangsu provincial government through the Jiangsu Province’s Outstanding Medical Academic Leader Program (RC2011087) and by the Jiangsu Provincial Center for Disease Control and Prevention (JKRC2011003). Additional support was made available through the University of California San Francisco (UCSF) Center for AIDS Prevention Studies (US National Institute of Mental Health P30 MH06224), the International Traineeships in AIDS Prevention Studies (R25MH064712), and the University of California Berkeley-UCSF AIDS International Training and Research Program (Fogarty International Center, D43TW000003). The authors thank the working group members from HIV/AIDS/STD prevention and control institute in JSCDC, for program implementation and assistance.

Conflict of interest

There are no conflicts of interest.


  1. 1.
    Ministry of Health of the People’s Republic of China. 2012 China AIDS Response Progress Report. Accessed 22 April 2012.
  2. 2.
    Lu L, Jia M, Ma Y, et al. The changing face of HIV in China. Nature. 2008;455(7213):609–11.PubMedGoogle Scholar
  3. 3.
    China Ministry of Health. 2011 Estimates for the HIV/AIDS Epidemic in China. Accessed 26 April 2012.
  4. 4.
    Wang L, Wang N, Wang L, et al. The 2007 estimates for people at risk for and living with HIV in China: progress and challenges. J Acquir Immune Defic Syndr. 2009;50(4):414–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Jiang J, Cao N, Zhang J, et al. High prevalence of sexually transmitted diseases among men who have sex with men in Jiangsu province. China Sex Transm Dis. 2006;33(2):118–23.CrossRefGoogle Scholar
  6. 6.
    Yan H, Zhang M, Li J, et al. Prevalence of sexually transmitted infections and the behavior characteristics of men who have sex with men in Jiangsu province. Chin Prev Med. 2010;11(12):1249–52.Google Scholar
  7. 7.
    Yang H, Hao C, Huan X, et al. HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing. China Sex Transm Dis. 2010;37(4):208–13.Google Scholar
  8. 8.
    Liu H, Yang H, Li X, et al. Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sex Transm Infect. 2006;33(2):68–76.Google Scholar
  9. 9.
    Shen J, Yu D. Governmental policies on HIV infection in China. Cell Res. 2005;15(11–12):903–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Ministry of Health of the People’s Republic of China. China 2010 UNGASS Country Progress Report (2008–2009). Accessed 30 April 2012.
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    BBC News. Aids takes deathly toll in China. February 18, 2009. Accessed 2 May 2012.
  13. 13.
    Zhang F, Dou Z, Yu L, et al. An ambispective cohort study of the natural history of HIV infection among former unsafe commercial blood and plasma donors. Zhonghua Liu Xing Bing Xue Za Zhi. 2008;29(1):9–12.PubMedGoogle Scholar
  14. 14.
    Zhang M, Shang H, Wang Z, Cui W, Hu Q. Natural history of HIV infection in former plasma donors in rural China. Front Med China. 2010;4(3):346–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Duan S, Zhang L, Xiang L, et al. Natural history of HIV infections among injecting drug users in Dehong prefecture, Yunnan province. Zhonghua Liu Xing Bing Xue Za Zhi. 2010;31(7):763–6.PubMedGoogle Scholar
  16. 16.
    Zheng X, Zhang J, Wang X, et al. The natural history of HIV infection among IDUs in Ruili, Yunnan province, China. Zhonghua Liu Xing Bing Xue Za Zhi. 2000;21(1):17–8.PubMedGoogle Scholar
  17. 17.
    Zhang F, Wang Y, Wang J, et al. National Free Antiretroviral Treatment Handbook (version 2). People’s Medical Publishing House; 2007.Google Scholar
  18. 18.
    Hao Y, Sun X, Wu Z, et al. AIDS comprehensive control and prevention manual. Peking University Medical Press; 2010.Google Scholar
  19. 19.
    National Center for AIDS/STD Control and Prevention of the Chinese Center for Disease Control and Prevention. Guideline for database HIV/AIDS case reporting and management. July 2008. Accessed 20 April 2012.
  20. 20.
    Degenhardt L, Hall W, Warner-Smith M. Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS. Sex Transm Infect. 2006;82(suppl 3):iii56–63.PubMedGoogle Scholar
  21. 21.
    Yoichi C, Kavita V. Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations. Brain Behav Immun. 2009;23(4):434–45.CrossRefGoogle Scholar
  22. 22.
    Zhou YR. Homosexuality, seropositivity, and family obligations: perspectives of HIV-infected men who have sex with men in China. Cult Health Sex. 2006;8(6):487–500.PubMedCrossRefGoogle Scholar
  23. 23.
    Li X, Lu H, Ma X, et al. HIV/AIDS-related stigmatizing and discriminatory attitudes and recent HIV testing among men who have sex with men in Beijing. AIDS Behav. 2012;16(3):499–507.PubMedCrossRefGoogle Scholar
  24. 24.
    Ruan Y, Pan SW, Chamot E, et al. Sexual mixing patterns among social networks of HIV-positive and HIV-negative Beijing men who have sex with men: a multilevel comparison using roundtable network mapping. AIDS Care. 2011;23(8):1014–25.PubMedCrossRefGoogle Scholar
  25. 25.
    Radcliffe J, Doty N, Hawkins LA, Gaskins CS, Beidas R, Rudy BJ. Stigma and sexual health risk in HIV-positive African American young men who have sex with men. AIDS Patient Care STDs. 2010;24(8):493–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Guo H, Wei J, Yang H, Huan X, Tsui SK, Zhang C. Rapidly increasing prevalence of HIV and syphilis and HIV-1 subtype characterization among men who have sex with men in Jiangsu. China Sex Transm Dis. 2009;36(2):120–5.CrossRefGoogle Scholar
  27. 27.
    Yang H, Xiao Z, Huan X, et al. Threshold survey of transmitted HIV-1 drug resistance in Jiangsu province. J Nanjing Univ. 2012;32(1):1–4.Google Scholar
  28. 28.
    Hsu LC, Vittinghoff E, Katz MH, Schwarcz SK. Predictors of use of highly active antiretroviral therapy (HAART) among persons with AIDS in San Francisco, 1996–1999. J Acquir Immune Defic Syndr. 2001;28(4):345–50.PubMedGoogle Scholar
  29. 29.
    Jain S, Schwarcz S, Katz M, Gulati R, McFarland W. Elevated risk of death for African Americans with AIDS, San Francisco, 1996–2002. J Health Care Poor Underserved. 2006;17(3):493–503.PubMedCrossRefGoogle Scholar
  30. 30.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Das M, Chu PL, Santos GM, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS ONE. 2010;5(6):e11068.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Hongjing Yan
    • 1
  • Haitao Yang
    • 1
  • Jianjun Li
    • 1
  • Chongyi Wei
    • 2
  • Jinshui Xu
    • 1
  • Xiaoyan Liu
    • 1
  • Xiaoqin Xu
    • 1
  • Willi McFarland
    • 3
    • 4
    Email author
  1. 1.Jiangsu Provincial Center for Diseases Control and PreventionNanjingChina
  2. 2.University of PittsburghPittsburghUSA
  3. 3.San Francisco Department of Public HealthSan FranciscoUSA
  4. 4.University of CaliforniaSan FranciscoUSA

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