Current HIV/AIDS Reports

, Volume 11, Issue 2, pp 134–145

Changing Patterns of HIV Epidemic in 30 Years in East Asia

  • S. Pilar Suguimoto
  • Teeranee Techasrivichien
  • Patou Masika Musumari
  • Christina El-saaidi
  • Bhekumusa Wellington Lukhele
  • Masako Ono-Kihara
  • Masahiro Kihara
The Global Epidemic (S Vermund, Section Editor)

Abstract

The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.

Keywords

East Asia Japan China Taiwan Hong Kong South Korea Mongolia HIV AIDS HIV testing MSM Epidemiology Global epidemic 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    UNAIDS: Global report: UNAIDS report on the global AIDS Epidemic 2013. Switzerland; 2013.Google Scholar
  2. 2.
    Piot P, Quinn TC. Response to the AIDS pandemic–a global health model. N Engl J Med. 2013;368(23):2210–8.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Quinn TC. Global burden of the HIV pandemic. Lancet. 1996;348(9020):99–106.PubMedCrossRefGoogle Scholar
  4. 4.
    Central Intelligence Agency: The World Factbook 2013-14 [https://www.cia.gov/library/publications/the-world-factbook/index.html] (Last accessed: January 19th, 2014).
  5. 5.
    Ministry of Health of the People's Republic of China, UNAIDS, WHO: 2011 Estimates for the HIV/AIDS epidemic in China; 2011.Google Scholar
  6. 6.••
    Zhang L, Chow EP, Jing J, Zhuang X, Li X, He M, et al. HIV prevalence in China: integration of surveillance data and a systematic review. Lancet Infect Dis. 2013;13(11):955–63. The authors analyzed the HIV prevalence trends between 1990 and 2012.They collected data from more than 1800 sentinel sites across all Chinese provinces and did a systematic review of 821 independent published studies. Their study showed that HIV prevalence among MSM is increasing at an alarming rate across all regions, suggesting that sex between men has become the main route of transmission.PubMedCrossRefGoogle Scholar
  7. 7.
    Wu Z, Sullivan S. China. In: Yamamoto T, Itoh S, editors. Fighting a Rising Tide: The Response to AIDS in East Asia, Wu Z, Sullivan S. Tokyo: Japan Center for International Exchange; 2006. p. 76–95.Google Scholar
  8. 8.
    Zhang Kl KL, Ma SJ. Epidemiology of HIV in China. BMJ. 2002;324(7341):803–4.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Xiao Y, Kristensen S, Sun J, Lu L, Vermund SH. Expansion of HIV/AIDS in China: Lessons from Yunnan Province. Soc Sci Med. 2007;64(3):665–75.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Wu Z, Liu Z, Detels R. HIV-1 infection in commercial plasma donors in China. Lancet. 1995;346(8966):61–2.PubMedCrossRefGoogle Scholar
  11. 11.
    Dou Z, Chen RY, Wang Z, Ji G, Peng G, Qiao X, et al. HIV-infected former plasma donors in rural Central China: from infection to survival outcomes, 1985-2008. PLoS One. 2010;5(10):e13737.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Sheng L, Cao WK. HIV/AIDS epidemiology and prevention in China. Chin Med J (Engl). 2008;121(13):1230–6.Google Scholar
  13. 13.
    Wu Z, Sun X, Sullivan SG, Detels R. HIV Testing in China. Science. 2006;312(5779):1475–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Ministry of Health of the People's Republic of China, UNAIDS, WHO: 2005 Update on the HIV/AIDS Epidemic and Response in China. Beijing; 2006.Google Scholar
  15. 15.
    He N, Detels R. The HIV epidemic in China: history, response, and challenge. Cell Res. 2005;15(11–12):825–32.PubMedCrossRefGoogle Scholar
  16. 16.
    Sullivan SG, Wu Z. Rapid scale up of harm reduction in China. Int J Drug Pol. 2007;18(2):118–28.CrossRefGoogle Scholar
  17. 17.
    Ministry of Health of the People's Republic of China: 2012 China AIDS Response Progress Report; 2012.Google Scholar
  18. 18.••
    Wu Z, Xu J, Liu E, Mao Y, Xiao Y, Sun X, et al. HIV and Syphilis Prevalence Among Men Who Have Sex With Men: A Cross-Sectional Survey of 61 Cities in China. Clin Infect Dis. 2013;57(2):298–309. This study is a rigorous epidemiologic work on more than 47,000 MSM; probably the largest study to date on HIV and syphilis prevalence among MSM. The authors found high prevalence of HIV and syphilis with similar risk factors but distinct geographical distribution, attributed by the authors to diverse transmission dynamics.PubMedCrossRefGoogle Scholar
  19. 19.
    UNAIDS: HIV in China: Facts and Figures [http://www.unaids.org.cn/en/index/page.asp?id = 197&class = 2&classname = China + Epidemic + %26 + Response] (Last accessed: January 10th, 2013).
  20. 20.
    Zhong F, Lin P, Xu H, Wang Y, Wang M, He Q, et al. Possible increase in HIV and syphilis prevalence among men who have sex with men in Guangzhou, China: results from a respondent-driven sampling survey. AIDS Behav. 2011;15(5):1058–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Chow EP, Wilson DP, Zhang L. HIV and syphilis co-infection increasing among men who have sex with men in China: a systematic review and meta-analysis. PLoS One. 2011;6(8):e22768.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Chow EP, Jing J, Feng Y, Min D, Zhang J, Wilson DP, et al. Pattern of HIV testing and multiple sexual partnerships among men who have sex with men in China. BMC Infect Dis. 2013;13(1):549.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Feng Y, Wu Z, Detels R. Evolution of men who have sex with men community and experienced stigma among men who have sex with men in Chengdu, China. J Acquir Immune Defic Syndr. 2010;53 Suppl 1:S98–103.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.•
    Chow EP, Wilson DP, Zhang L. What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis. BMC Infect Dis. 2011;11:242. This study provides a comprehensive analysis of the bisexual characteristics of Chinese MSM during 2001 to 2010. Bisexual behavior among MSM is common in China to conceal their homosexuality and conform to Chinese social norms.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Yang Z, Su J, Peng X, Wu N. A Decline in HIV and Syphilis Epidemics in Chinese Female Sex Workers (2000-2011): A Systematic Review and Meta-Analysis. PLoS One. 2013;8(12):e82451.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Yingying H, Smith K, Suiming P. Changes and correlates in multiple sexual partnerships among Chinese adult women–population-based surveys in 2000 and 2006. AIDS Care. 2011;23 Suppl 1:96–104.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Liu J, Huang Y, Wang J, Guo N, Li J, Dong X, et al. The increasing prevalence of serologic markers for syphilis among Chinese blood donors in 2008 through 2010 during a syphilis epidemic. Transfusion (Paris). 2012;52(8):1741–9.CrossRefGoogle Scholar
  28. 28.
    Qian HZ, Vermund SH, Wang N. Risk of HIV/AIDS in China: subpopulations of special importance. Sex Transm Infect. 2005;81(6):442–7.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Evolution of China’s response to HIV/AIDS. Lancet. 2007;369(9562):679–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Lau JT, Lin C, Hao C, Wu X, Gu J. Public health challenges of the emerging HIV epidemic among men who have sex with men in China. Public Health. 2011;125(5):260–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Centers for Disease Control R.O.C. (Taiwan): HIV/AIDS [http://www.cdc.gov.tw/english/page.aspx?treeid = e79c7a9e1e9b1cdf&nowtreeid = 6bb9113c9e323e98] (Last accessed: December 25, 2013).
  32. 32.
    Study Group on HIV Infection of Haemophiliacs: Report of the study group on HIV infection of haemophiliacs through blood products in Hong Kong. Hong Kong; 1993.Google Scholar
  33. 33.
    Feldman EA. HIV and Blood in Japan: Transforming Private Conflict into Public Scandal. In: Feldman EA, editor. Blood Feuds: AIDS, Blood, and the Politics of Medical Disaster. New York: Oxford University Press; 1999.Google Scholar
  34. 34.
    Centers for Disease Control R.O.C. (Taiwan): HIV/AIDS (1984 - 2012/12/31) [http://www.cdc.gov.tw/english/info.aspx?treeid = 00ED75D6C887BB27&nowtreeid = 334C2073091C8677&tid = EA2CB016562D29C9] (Last accessed: January 17th, 2014).
  35. 35.
    Centers for Disease Control R.O.C. (Taiwan): Annual reported number of cases of HIV among Taiwanese by risk factor [http://www.cdc.gov.tw/professional/downloadfile.aspx?fid = 909C64F271CE1554] (Last accessed: January 19th, 2014).
  36. 36.
    Centers for Disease Control Ministry of Health and Welfare R.O.C. (Taiwan): Statistics of Communicable Diseases and Surveillance Report. Taipei; 2013.Google Scholar
  37. 37.
    Centers for Disease Control Ministry of Health and Welfare R.O.C. (Taiwan): Annual Report. Taipei; 2013.Google Scholar
  38. 38.
    UNAIDS: Welcome (not) [http://www.unaids.org/en/resources/infographics/20120514travel/] (Last accessed: January 18th, 2014).
  39. 39.
    Chu FY, Chiang SC, Su FH, Chang YY, Cheng SH. Prevalence of human immunodeficiency virus and its association with hepatitis B, C, and D virus infections among incarcerated male substance abusers in Taiwan. J Med Virol. 2009;81(6):973–8.PubMedCrossRefGoogle Scholar
  40. 40.•
    Ko N-Y, Lee H-C, Hung C-C, Tseng F-C, Chang J-L, Lee N-Y, et al. Trends of HIV and Sexually Transmitted Infections, Estimated HIV Incidence, and Risky Sexual Behaviors Among Gay Bathhouse Attendees in Taiwan: 2004–2008. AIDS Behav. 2011;15(2):292–7. The paper identifies increasing HIV prevalence in MSM attending bathhouses in Taiwan from 2004-2007. Revealing that behavior is extremely risky, approximately 20%-30% of UAS and MSP and 80% of unprotected oral sex in the last visit to bathhouse. Recreational drug use may lead them to the perpetuating risk behaviors. Interventions at bath house are urgently needed.PubMedCrossRefGoogle Scholar
  41. 41.
    Ko N-Y, Koe S, Lee H-C, Yen C-F, Ko W-C, Hsu S-T. Online Sex-Seeking, Substance Use, and Risky Behaviors in Taiwan: Results from the 2010 Asia Internet MSM Sex Survey. Arch Sex Behav. 2012;41(5):1273–82.PubMedCrossRefGoogle Scholar
  42. 42.
    Lin HH, Shih YL, Liu YC, Lee SS, Huang CK, Chen YL, et al. An epidemic of HIV type I CRF07_BC infection among injection drug users in Taiwan. J Acquir Immune Defic Syndr. 2006;42(2):248–55.PubMedCrossRefGoogle Scholar
  43. 43.
    Lin Y-T, Lan Y-C, Chen Y-J, Huang Y-H, Lee C-M, Liu T-T, et al. Molecular Epidemiology of HIV-1 Infection and Full-Length Genomic Analysis of Circulating Recombinant Form 07_BC Strains from Injection Drug Users in Taiwan. J Infect Dis. 2007;195(9):1283–93.PubMedCrossRefGoogle Scholar
  44. 44.
    Chen Y-MA, Lan Y-C, Lai S-F, Yang J-Y, Tsai S-F, SH-S K: HIV-1 CRF07_BC infections, injecting drug users, Taiwan [letter]. Emerg Infect Dis 2006.Google Scholar
  45. 45.
    Lee TS, Shen HC, Wu WH, Huang CW, Yen MY, Wang BE, et al. Clinical characteristics and risk behavior as a function of HIV status among heroin users enrolled in methadone treatment in northern Taiwan. Subst Abuse Treat Prev Policy. 2011;6:6.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Liu JY, Lin HH, Liu YC, Lee SS, Chen YL, Hung CC, et al. Extremely high prevalence and genetic diversity of hepatitis C virus infection among HIV-infected injection drug users in Taiwan. Clin Infect Dis. 2008;46(11):1761–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Chen Y-MA, Chen Y-H, Lin Y-T, Lim P-L, Yunihastuti E, Kiertiburanakul S, Merati T, Chaiwarith R, Phanuphak P, Li P-C et al: Hepatitis B (HBV) and hepatitis C (HCV) co-infection: long term immunological, virological and survival outcomes following cART. In: 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur; 2013.Google Scholar
  48. 48.
    Ko NY, Lee HC, Chang JL, Lee NY, Chang CM, Lee MP, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in taiwan. Sex Transm Dis. 2006;33(8):467–73.PubMedCrossRefGoogle Scholar
  49. 49.
    Tung WC, Ding K, Farmer S. Knowledge, attitudes, and behaviors related to HIV and AIDS among college students in Taiwan. J Assoc Nurses AIDS Care. 2008;19(5):397–408.PubMedCrossRefGoogle Scholar
  50. 50.
    Kihara M, Ono-Kihara M, Feldman MD, Ichikawa S, Hashimoto S, Eboshida A, et al. HIV/AIDS surveillance in Japan, 1984-2000. J Acquir Immune Defic Syndr. 2003;32 Suppl 1:S55–62.PubMedCrossRefGoogle Scholar
  51. 51.
    Study Group on HIV/AIDS Epidemiology and Intervention: Surveillance and preventive activities for HIV/AIDS infection among high risk populations and monitoring of local and global epidemiologic trends of HIV/AIDS. Japan; 2013.Google Scholar
  52. 52.
    Japan Foundation for AIDS Prevention: Japan: HIV/AIDS update. ICAAP11, Bangkok, Thailand, November 18-22 2013.Google Scholar
  53. 53.
    Ichikawa S, Kaneko N, Koerner J, Shiono S, Shingae A, Ito T. Survey investigating homosexual behaviour among adult males used to estimate the prevalence of HIV and AIDS among men who have sex with men in Japan. Sex Health. 2011;8(1):123–4.PubMedCrossRefGoogle Scholar
  54. 54.
    Kojima H: The Viewpoint of a Specialist from an Outsourced HIV Counseling and Testing Service. In: 22nd Japanese Society for AIDS Research. Osaka, Japan; 2008.Google Scholar
  55. 55.
    Ministry of Health Labour and Welfare (MHLW): Annual Report of the National AIDS Surveillance Committee for year 2012. Tokyo; 2013.Google Scholar
  56. 56.
    Hidaka Y, Ichikawa S, Koyano J, Urao M, Yasuo T, Kimura H, et al. Substance use and sexual behaviours of Japanese men who have sex with men: a nationwide internet survey conducted in Japan. BMC Public Health. 2006;6:239.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Nishijima T, Gatanaga H, Komatsu H, Takano M, Ogane M, Ikeda K, et al. High Prevalence of Illicit Drug Use in Men Who Have Sex with Men with HIV-1 Infection in Japan. PLoS One. 2013;8(12):e81960.PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.••
    Gilmour S, Li J, Shibuya K. Projecting HIV transmission in Japan. PLoS One. 2012;7(8):e43473. This study highlights the need for new strategies to reach the MSM population. It points out gaps in the current knowledge about the key risk behaviors among this population and provides some recommendations.PubMedCentralPubMedCrossRefGoogle Scholar
  59. 59.
    Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining Morbidity and Mortality among Patients with Advanced Human Immunodeficiency Virus Infection. N Engl J Med. 1998;338(13):853–60.PubMedCrossRefGoogle Scholar
  60. 60.
    Itoh S. Japan. In: Yamamoto T, Itoh S, editors. Fighting a Rising Tide: The Response to AIDS in East Asia. Tokyo: Japan Center for International Exchange (JCIE); 2006. p. 119–55.Google Scholar
  61. 61.
    Korea Centers for Disease Control and Prevention: Annual Report on the Notified HIV/AIDS in Korea; 2013.Google Scholar
  62. 62.
    Korea Centers for Disease Control and Prevention: HIV/AIDS Control in the Republic of Korea. Seoul; 2011.Google Scholar
  63. 63.
    Lee JH, Hong KJ, Wang JS, Kim SS, Kee MK. Estimation of hospital-based HIV seroprevalence as a nationwide scale by novel method; 2002-2008 in Korea. BMC Public Health. 2010;10:739.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.•
    Kee MK, Lee JH, Whang J, Kim SS. Ten-year trends in HIV prevalence among visitors to public health centers under the National HIV Surveillance System in Korea, 2000 to 2009. BMC Public Health. 2012;12:831. Large study (HIV/AIDS Cohort 2006) in Korea showing low HIV prevalence among high risk groups attending public health centers. Also, showed that HIV prevalence among “anonymous testers” was highest highlighting the importance to ascertain the characteristics of people choosing to take voluntary testing.PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Yu H-K, Kim N-Y, Kim SS, Chu C, Kee M-K. Forecasting the Number of Human Immunodeficiency Virus Infections in the Korean Population Using the Autoregressive Integrated Moving Average Model. Osong Public Health Res Perspect. 2013;4(6):358–62.PubMedCentralPubMedCrossRefGoogle Scholar
  66. 66.
    Korea Centers for Disease Control and Prevention: 2011 Annual Report on the Notified HIV/AIDS in Korea; 2012.Google Scholar
  67. 67.
    Kweon S-S, Shin M-H, Song H-J, Jeon D-Y, Choi J-S. Seroprevalence and Risk Factors for Hepatitis C Virus Infection Among Female Commercial Sex Workers in South Korea Who are not Intravenous Drug Users. Am J Trop Med Hyg. 2006;74(6):1117–21.PubMedGoogle Scholar
  68. 68.
    Surin S. Republic of Korea. In: Yamamoto T, Itoh S, editors. Fighting a Rising Tide: the Reponse to AIDS in East Asia. Tokyo: Japan Center for International Exchange; 2006. p. 156–71.Google Scholar
  69. 69.
    Lee J-H, Kim SH, Wang J-S, Sung KM, Kim SS, Kee M-K. Epidemiological and Immunological Characteristics at the Time of HIV Diagnosis for HIV/AIDS Cohort Registrants Representative of HIV-Infected Populations in Korea. Osong Public Health Res Perspect. 2012;3(2):100–6.PubMedCentralPubMedCrossRefGoogle Scholar
  70. 70.
    Sohn A, Cho B. Knowledge, Attitudes, and Sexual Behaviors in HIV/AIDS and Predictors Affecting Condom Use among Men Who Have Sex with Men in South Korea. Osong Public Health Res Perspect. 2012;3(3):156–64.PubMedCentralPubMedCrossRefGoogle Scholar
  71. 71.
    Jung M, Lee J, Kwon DS, Park B-J. Comparison of Sexual Risky Factors of Men Who Have Sex With Men and Sex-buying Men as Groups Vulnerble to Sexually Transmitted Diseases. J Prev Med Public Health. 2012;45(3):156–63.PubMedCentralPubMedCrossRefGoogle Scholar
  72. 72.
    Sohn A, Park S. HIV/AIDS Knowledge, Stigmatizing Attitudes, and Related Behaviors and Factors that Affect Stigmatizing Attitudes against HIV/AIDS among Korean Adolescents. Osong Public Health Res Perspect. 2012;3(1):24–30.PubMedCentralPubMedCrossRefGoogle Scholar
  73. 73.
    Min JA, Yoon Y, Lee HJ, Choi J, Kwon M, Kim K, et al. Prevalence and associated clinical characteristics of hepatitis B, C, and HIV infections among injecting drug users in Korea. J Med Virol. 2013;85(4):575–82.PubMedCrossRefGoogle Scholar
  74. 74.•
    Lee SH, Kim KH, Lee SG, Chen DH, Jung DS, Moon CS, et al. Trends of mortality and cause of death among HIV-infected patients in Korea, 1990-2011. J Korean Med Sci. 2013;28(1):67–73. This study revealed that a high proportion of patients are presenting late to care thus having early mortality. In a time when antiretroviral treatment is available, this study underlines the importance for early testing and diagnosing to get appropiate care.PubMedCentralPubMedCrossRefGoogle Scholar
  75. 75.
    Choe PG, Park WB, Song JS, Kim NH, Park JY, Song KH, et al. Late presentation of HIV disease and its associated factors among newly diagnosed patients before and after abolition of a government policy of mass mandatory screening. J Infect. 2011;63(1):60–5.PubMedCrossRefGoogle Scholar
  76. 76.
    Kee MK, Lee JH, Kim EJ, Lee J, Nam JG, Yoo BH, et al. Improvement in survival among HIV-infected individuals in the Republic of Korea: need for an early HIV diagnosis. BMC Infect Dis. 2009;9:128.PubMedCentralPubMedCrossRefGoogle Scholar
  77. 77.
    Kim YG, Hahn SJ. Homosexuality in ancient and modern Korea. Cult Health Sex. 2006;8(1):59–65.PubMedCrossRefGoogle Scholar
  78. 78.
    Sohn A, Chun SS. Gender differences in sexual behavior and condom-related behaviours and attitudes among Korean youths. Asia Pac J Public Health. 2007;19(2):45–52.PubMedCrossRefGoogle Scholar
  79. 79.
    Sohn A, Park S. Changes in Human Immunodeficiency Virus-related Knowledge and Stigmatizing Attitudes among Korean Adolescents from 2006 to 2011. Osong Public Health Res Perspect. 2012;3(2):107–12.PubMedCentralPubMedCrossRefGoogle Scholar
  80. 80.
    Hong Kong Advisory Council on AIDS: Annual Report August 2009 - July 2010; 2011.Google Scholar
  81. 81.
    Special Preventive Programme Centre for Health Protection: HIV Surveillance Report: 2011 Update. Kowloon, Hong Kong; December 2012.Google Scholar
  82. 82.
    Special Preventive Programme Centre for Health Protection: Factsheet on HIV/AIDS Situation in Hong Kong. Kowloon, Hong Kong; 2012.Google Scholar
  83. 83.
    Lee SS, Tam DK, Mak DW, Wong K. Use of the Internet for sex partnership in men who have sex with men before HIV infection. Public Health. 2011;125:433–5.PubMedCrossRefGoogle Scholar
  84. 84.
    Lau JF, Cai W, Tsui H, Cheng J, Chen L, Choi K, et al. Prevalence and Correlates of Unprotected Anal Intercourse Among Hong Kong Men Who Have Sex with Men Traveling to Shenzhen. China. AIDS Behav. 2013;17(4):1395–405.PubMedCrossRefGoogle Scholar
  85. 85.
    Ho R, Wong K: Programme manager’s viewpoint: Hong Kong (China) experience in combating the HIV epidemic among men who have sex with men. HIV/AIDS Prevention and Care Newsletter 2010:3-5.Google Scholar
  86. 86.
    Chan MK, Lee S. Can the low prevalence in Hong Kong be maintained? AIDS Educ Prev. 2004;16(A):18–26.PubMedCrossRefGoogle Scholar
  87. 87.
    Lee SS. The contribution of methadone maintenance treatment to HIV prevention - The case of Hong Kong. In: International Conference on Tackling Drug Abuse - Conference Proceedings. Hong Kong: Narcotics Division; 2005. p. 191–205.Google Scholar
  88. 88.
    Special Preventive Programme Centre for Health Protection: Factsheet HIV/AIDS Situation in Hong Kong. Kowloon, Hong Kong; 2010.Google Scholar
  89. 89.
    Li H, Goggins W, Lee SS: Multilevel analysis of HIV related risk behaviors among heroin users in a low prevalence community. BMC Public Health 2009, 9(137).Google Scholar
  90. 90.
    Lee KC, Lim WW, Lee SS. High prevalence of HCV in a cohort of injectors on methadone substitution treatment. J Clin Virol. 2008;41(4):297–300.PubMedCrossRefGoogle Scholar
  91. 91.
    Wong WCW, Yim YL, Lynn H. Sexually Transmitted Infections Among Female Sex Workers in Hong Kong: The Role of Migration Status. J Travel Med. 2011;18(1):1–7.PubMedCrossRefGoogle Scholar
  92. 92.
    Lau JT, Tsui HY. Behavioral surveillance surveys of the male clients of female sex workers in Hong Kong: results of three population-based surveys. Sex Transm Dis. 2003;30(8):620–8.PubMedCrossRefGoogle Scholar
  93. 93.
    Government of Mongolia: AIDS reponse progress reporting. Mongolia; 2012.Google Scholar
  94. 94.
    Tserenpuntsag B, Ouynbileg L, Nelson K, McNutt LA. Prevalence of infectious diseases among Mongolian blood donors. J Infect Dev Ctries. 2008;2(1):73–5.PubMedCrossRefGoogle Scholar
  95. 95.
    Davaalkham J, Unenchimeg P, Baigalmaa C, Oyunbileg B, Tsuchiya K, Hachiya A, et al. High-risk status of HIV-1 infection in the very low epidemic country, Mongolia, 2007. Int J STD AIDS. 2009;20(6):391–4.PubMedCrossRefGoogle Scholar
  96. 96.
    Amindavaa O, Kristensen S, Pak CY, Khalzan D, Chultemsuren B, Randall AS, et al. Sexually transmitted infections among pregnant women attending antenatal clinics in Mongolia: potential impact on the Mongolian HIV epidemic. Int J STD AIDS. 2005;16(2):153–7.PubMedCrossRefGoogle Scholar
  97. 97.
    National Center for Communicable Diseases (NCCD): HIV/AIDS cases ovierview [http://www.nccd.gov.mn/index.php?option=com_content&view=article&id=386:2013-11-29-05-29-40&catid=21:2011-09-01-03-24-23&Itemid=42] (Last accessed: January 19th, 2014).
  98. 98.
    Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Report. Mongolia; 2005.Google Scholar
  99. 99.
    Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Report. Mongolia; 2007.Google Scholar
  100. 100.
    Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Report. Mongolia; 2009.Google Scholar
  101. 101.
    Mongolia National Committee on HIV and AIDS: UNGASS Country Progress Report: Mongolia; 2010.Google Scholar
  102. 102.••
    Mongolia Ministry of Health: Second Generation HIV/STI Surveillance Survey. Mongolia; 2011. This is a major source of informtion regarding the HIV epidemic in Mongolia since limited research has been published in English. Google Scholar
  103. 103.•
    Yasin F, Delegchoimbol A, Jamiyanjamts N, Sovd T, Mason K, Baral S. A cross-sectional evaluation of correlates of HIV testing practices among men who have sex with men (MSM) in Mongolia. AIDS Behav. 2013;17(4):1378–85. This study used a rigourous methodology and provided data on HIV prevalence, patterns and associations of HIV testing, and HIV related knowledge among MSM.PubMedCrossRefGoogle Scholar
  104. 104.
    Mathers B, Wodak A, Shakeshaft A, Merghati Khoei E, Dolan K: A rapid assessment and response to HIV and drug use in Mongolia. Sydney; 2009.Google Scholar
  105. 105.
    National Committee on HIV/AIDS: Mongolian National Strategic Plan on HIV, AIDS and STIs, 2010-2015. Ulaanbaatar; 2010.Google Scholar
  106. 106.
    Yasin F, Delegchoimbol A, Jamiyanjamts N, Mason K, Baral S: A cross-sectional assessment of HIV risk status and human rights abuses among men who have sex with men (MSM) in Mongolia [Poster]. XIX International AIDS Conference, July 22-27 Washington DC, USA 2012.Google Scholar
  107. 107.
    Tsai LC, Witte SS, Aira T, Riedel M, Hwang HG. Ssewamala F: “There is no other option; we have to feed our families…who else would do it?”: The financial lives of women engaging in sex work in Ulaanbaatar. Mongolia. Glob J Health Sci. 2013;5(5):41–50.PubMedGoogle Scholar
  108. 108.•
    Witte SS, Altantsetseg B, Aira T, Riedel M, Chen J, Potocnik K, et al. Reducing sexual HIV/STI risk and harmful alcohol use among female sex workers in Mongolia: a randomized clinical trial. AIDS Behav. 2011;15(8):1785–94. This study shows that even low impact interventions can achieve reductions of HIV and STI risk among FSW. Feasable and positively endorsed interventions are particularly important in low resourced settings.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • S. Pilar Suguimoto
    • 1
  • Teeranee Techasrivichien
    • 1
  • Patou Masika Musumari
    • 1
  • Christina El-saaidi
    • 1
  • Bhekumusa Wellington Lukhele
    • 1
  • Masako Ono-Kihara
    • 1
  • Masahiro Kihara
    • 1
  1. 1.Department of Global Health and Socio-epidemiologyKyoto University School of Public HealthKyotoJapan

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