“Getting to Zero” Among Men Who Have Sex with Men in China: a Review of the HIV Care Continuum
- 34 Downloads
Purpose of Review
To review the literature on progress towards UNAIDS 90-90-90 targets for HIV prevention and treatment among men who have sex with men (MSM) in China.
China has made progress towards UNAIDS 90-90-90 targets among MSM. However, socio-structural barriers, including HIV-related stigma and homophobia, persist at each stage of the HIV care continuum, leading to substantial levels of attrition and high risk of forward HIV transmission. Moreover, access to key prevention tools, such as pre-exposure prophylaxis, is still limited. Multilevel interventions, many using digital intervention, have been shown effective in pragmatic randomized controlled trials in China.
Multilevel interventions incorporating digital health have led to significant improvement in engagement of Chinese MSM in the HIV care continuum. However, interventions that address socio-structural determinants, including HIV-related stigma and discrimination, towards Chinese MSM are needed.
KeywordsHIV MSM China Review Treatment Prevention
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Avert. HIV and AIDS in China. 2019. Available at: https://www.avert.org/professionals/hiv-around-world/asia-pacific/china. Accessed 23 July 2019.
- 2.Joint United Nations Programme on HIV/AIDS (UNAIDS). 90-90-90 an ambitious treatment target to help end the AIDS epidemic. 2014. Available at: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Accessed 25 April 2019.
- 3.• Ma Y, Dou Z, Guo W, Mao Y, Zhang F, JM MG, et al. The human immunodeficiency virus care continuum in China: 1985–2015. Clin Infect Dis. 2018;66(6):833–9 This nationwide analysis looks at the HIV care continuum across China according to key populations and other important subgroups. PubMedCrossRefPubMedCentralGoogle Scholar
- 4.Hu H, Liu X, Zhang Z, Xu X, Shi L, Fu G, et al. Increasing HIV incidence among men who have sex with men in Jiangsu Province, China: Results from five consecutive surveys, 2011–2015. International journal of environmental research and public health. 2016;13(8):795.PubMedCentralCrossRefGoogle Scholar
- 8.National Health and Family Planning Commission of the People’s Republic of China. 2015 China AIDS response progress report 2015. Available at: https://www.unaids.org/sites/default/files/country/documents/CHN_narrative_report_2015.pdf. Accessed 7 February 2019.
- 13.Ren XL, Mi GD, Zhao Y, Rou KM, Zhang DP, Geng L, et al. [The situation and associated factors of facility-based HIV testing among men who sex with men in Beijing]. Zhonghua Yu Fang Yi Xue Za Zhi. 2017;51(4):341–6.Google Scholar
- 16.Chinese Centers for Disease Control and Prevention [CDC]. Information about HIV testing. 2018. Available from: http://www.chinacdc.cn/jkzt/crb/zl/azb/zstd/201811/t20181116_197341.html. Accessed on July 1, 2019.
- 17.Liu SL, Xu P, Qi Y, Lu F. Analysis of the policy implication of real name HIV testing. Chin J STD/AIDS Prev Cont. 2012;5:327–9.Google Scholar
- 20.CDC. The cost of HIV testing in China. 2018. Available from: https://www.hiv-cdc.com/aizizhishi/725.html. Accessed 10 May 2019.
- 22.Wan S, Wang S, Deng S, Liao Q. Service efficiency of community-based organizations for HIV infected persons and AIDS patients. Pract J Clin Med. 2014;3:70–2.Google Scholar
- 23.Hao Y, Shan D, Fu X, Qi J, Meng S, Li C, et al. [The feasibility of community health service center-based HIV prevention and intervention in China]. Zhonghua Yu Fang Yi Xue Za Zhi. 2014;48(5):386–90.Google Scholar
- 24.Tang X, Zhang J, Pan R, Yu X, Chen K, Zhang J, et al. An analysis on effects of cooperation with community-based organizations in HIV testing mobilization and follow up among men who have sex with men. Chin J STD/AIDS Prev Cont. 2015;1:62–4.Google Scholar
- 25.World Health Organization [WHO]. Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counselling, correct results and connection 2015. 2015.Google Scholar
- 26.Wang XF, Wu ZY, Tang ZZ, Nong QX, Li YQ. [Acceptability of HIV testing using oral quick self-testing kit in men who have sex with men]. Zhonghua Liu Xing Bing Xue Za Zhi 2018;39(7):937–42.Google Scholar
- 27.Ren XL, Mi GD, Zhao Y, Rou KM, Zhang DP, Geng L, et al. [The situation and associated factors of facility-based HIV testing among men who sex with men in Beijing]. Zhonghua Yu Fang Yi Xue Za Zhi. 2017;51(4):341–6.Google Scholar
- 28.Zun-You WU. The progress and challenges of promoting HIV/AIDS 90-90-90 strategies in China. J Chin J Dis Control Prev. 2016.Google Scholar
- 29.Tang X, Zhang J, Pan R, Yu X, Chen K, Zhang J, et al. An analysis on effects of cooperation with community-based organizations in HIV testing mobilization and follow up among men who have sex with men. Chin J STD/AIDS Prev Cont. 2015;1:62–4.Google Scholar
- 30.Luo X, Xu X, Fan C, Peng L, Peng C, Yang L. An exploration of expansion of HIV counselling and testing comprehensive services in general hospitals. Chin J STD/AIDS Prev Cont. 2014;6:449–50.Google Scholar
- 32.Wang XF, Wu ZY, Tang ZZ, Nong QX, Li YQ. [Acceptability of HIV testing using oral quick self-testing kit in men who have sex with men]. Zhonghua Liu Xing Bing Xue Za Zhi 2018;39(7):937–42.Google Scholar
- 33.World Health Organization [WHO]. Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counselling, correct results and connection 2015. 2015.Google Scholar
- 34.Wang XF, Wu ZY, Tang ZZ, Nong QX, Li YQ. [Acceptability of HIV testing using oral quick self-testing kit in men who have sex with men]. Zhonghua Liu Xing Bing Xue Za Zhi 2018;39(7):937–42.Google Scholar
- 35.Organization WH. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services: World Health Organization; 2016.Google Scholar
- 36.Yan L, Xiao P, Yan H, Huan X, Fu G, Li J, et al. The advance of detection technology of HIV self-testing. Chin J Prev Med. 2017;51(11):1053–6.Google Scholar
- 40.•• Tang W, Wei C, Cao B, Wu D, Li KT, Lu H, et al. Crowdsourcing to expand HIV testing among men who have sex with men in China: a closed cohort stepped wedge cluster randomized controlled trial. PLoS Med. 2018;15(8):e1002645 This pragmatic RCT demonstrates that crowdsourcing can develop effective services to enhance HIV testing among MSM in China.PubMedPubMedCentralCrossRefGoogle Scholar
- 42.• Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, et al. Acceptability and feasibility of a social entrepreneurship testing model to promote HIV self-testing and linkage to care among men who have sex with men. HIV Med. 2017;18(5):376–82 This study examines a pilot program for delivering HIV self-test kits to MSM through a social entrepreneurship approach. PubMedCrossRefPubMedCentralGoogle Scholar
- 43.Wu D, Tang W, Ong J, Smith MK, Ritchwood TD, Fu HT, Pan S & Tucker JD. Social-media based secondary distribution of HIV self-testing among Chinese men who have sex with men: a pilot implementation program assessment. Oral presentation at the 10th IAS Conference on HIV Science (IAS 2019), Mexico City, Mexico.Google Scholar
- 44.Liu F, Han L, Tang W, Huang S, Yang L, Zheng H, Yang B, Tucker JD. Availability and quality of online HIV self-test kids in China and the United States. Poster presented at the Conference on Retroviruses and Opportunistic Infections (2015), Seattle, Washington.Google Scholar
- 45.•• Wang L, Podson D, Chen Z, Lu H, Wang V, Shepard C, et al. Using social media to increase hiv testing among men who have sex with men - Beijing, China, 2013–2017. MMWR Morb Mortal Wkly Rep. 2019;68(21):478–82 This multisite study suggests how social network applications can broadcast HIV testing promotion messages and disseminate them through online networks. PubMedPubMedCentralCrossRefGoogle Scholar
- 46.Cheng WB, Xu HF, Zhong F, Cai YS, Chen XB, Meng G, et al. [Application of “Internet Plus” AIDS prevention services among men who have sex with men in Guangzhou, China: results from 2010 to 2015]. Zhonghua Yu Fang Yi Xue Za Zhi. 2016;50(10):853–7.Google Scholar
- 47.Wang Z, Lau JTF, Ip M, Ho SPY, Mo PKH, Latkin C, et al. A randomized controlled trial evaluating efficacy of promoting a home-based HIV self-testing with online counseling on increasing HIV testing among men who have sex with men. AIDS Behav. 2018;22(1):190–201.PubMedCrossRefPubMedCentralGoogle Scholar
- 50.Chinese Center for Disease Control and Prevention: Guidelines for HIV/AIDS prevention among men who have sex with men 2016. 2016. Available at: http://www.chinacdc.cn/jkzt/crb/zl/azb/jszl_2219/201609/W020160922471323108736.pdf. Accessed on July 1, 2019.
- 51.Cheng W, Tang W, Zhong F, Babu GR, Han Z, Qin F, et al. Consistently high unprotected anal intercourse (UAI) and factors correlated with UAI among men who have sex with men: implication of a serial cross-sectional study in Guangzhou, China. BMC Infect Dis. 2014;14:696.PubMedPubMedCentralCrossRefGoogle Scholar
- 54.Wu Z, The progress and challenges of promoting HIV/AIDS 90-90-90 strategies in China. Chinese Journal of Disease Control & Prevention. 2016;20(12):1187-9.Google Scholar
- 57.Hao C, Huan X, Yan H, Yang H, Guan W, Xu X, et al. A randomized controlled trial to evaluate the relative efficacy of enhanced versus standard voluntary counseling and testing on promoting condom use among men who have sex with men in China. AIDS Behav. 2012;16(5):1138–47.PubMedCrossRefPubMedCentralGoogle Scholar
- 60.• Ding Y, Yan H, Ning Z, Cai X, Yang Y, Pan R, et al. Low willingness and actual uptake of pre-exposure prophylaxis for HIV-1 prevention among men who have sex with men in Shanghai, China. Biosci Trends. 2016;10(2):113–9 This PrEP demonstration project underlines some of the barriers to overcome in order to expand PrEP among MSM in China. PubMedCrossRefGoogle Scholar
- 65.PrEPMAP. Your guide to PrEP in Asia and the Pacific: PrEPMAP; 2019. Available from: https://www.prepmap.org/prep_status_by_country. Accessed 12 May 2019.
- 69.Li R, Wang H, Pan X, Ma Q, Chen L, Zhou X, et al. Prevalence of condomless anal intercourse and recent HIV testing and their associated factors among men who have sex with men in Hangzhou, China: a respondent-driven sampling survey. PLoS One. 2017;12(3):e0167730.PubMedPubMedCentralCrossRefGoogle Scholar
- 73.He L, Yang J, Ma Q, Zhang J, Xu Y, Xia Y, et al. Reduction in HIV community viral loads following the implementation of a “treatment as prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China. BMC Infect Dis. 2018;18(1):62.PubMedPubMedCentralCrossRefGoogle Scholar
- 76.Zhao Y, Wu Z, McGoogan JM, Sha Y, Zhao D, Ma Y, et al. Nationwide cohort study of antiretroviral therapy timing: treatment dropout and virological failure in China, 2011–2015. 2018;68(1):43–50.Google Scholar
- 78.Sun J, Liu L, Shen J, Chen P, HJBid L. Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study. BMC infectious diseases. 2017;17(1):285.Google Scholar
- 81.Cao B, Saha PT, Leuba SI, Lu H, Tang W, Wu D, et al. Recalling, sharing and participating in a social media intervention promoting HIV testing: a longitudinal analysis of HIV testing among MSM in China. AIDS Behav. 2019.Google Scholar
- 83.Tian T, Mijiti P, Bingxue H, Fadong Z, Ainiwaer A, Guoyao S, et al. Prevalence and risk factors of anal human papillomavirus infection among HIV-negative men who have sex with men in Urumqi city of Xinjiang Uyghur Autonomous Region, China. PloS One. 2017;12(11):e0187928.PubMedPubMedCentralCrossRefGoogle Scholar
- 85.• Cao B, Saha PT, Leuba SI, Lu H, Tang W, Wu D, Ong J, Liu C, Fu R, Wei C, Tucker JD. Recalling, Sharing and Participating in a Social Media Intervention Promoting HIV Testing: A Longitudinal Analysis of HIV Testing Among MSM in China. AIDS and behavior. 2019;23(5):1240-9.PubMedCrossRefPubMedCentralGoogle Scholar