Skip to main content

Advertisement

SpringerLink
Log in

HIV Services Uptake Among People Living with HIV in Jiangsu Province, China: A Cross-Sectional Study

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Healthcare disparities are common among people living with HIV (PLWH) in China and likely impact access to HIV services. This study aimed to assess the current status of access to HIV services among PLWH and explore the correlates of service uptake using baseline data from a prospective cohort study among PLWH in Jiangsu Province. Guided by Andersen’s behavioral model, univariable and multivariable logistic regressions were conducted to identify factors associated with access to HIV services. Out of 8989 eligible PLWH included in this study, 46.4% perceived difficulty in seeing a healthcare professional for HIV treatment services in 2021–2022. PLWH aged 18–34 years (adjusted odds ratio [AOR] = 1.69, 95% CI 1.32–2.15), 35–39 years (AOR = 1.33, 95% CI 1.08–1.65), identified as a bisexual/other (AOR = 1.14, 95% CI 1.01–1.29), had a college and above education (AOR = 1.32, 95% CI 1.07–1.63), and perceived moderate (AOR = 1.70, 95% CI 1.51–1.91) and severe (AOR = 2.20, 95% CI 1.94–2.49) levels of HIV stigma were more likely to perceive difficulty in seeing healthcare professionals for HIV treatment in 2021–2022. Living in northern Jiangsu was also associated with increased odds of perceiving difficulty in seeing healthcare professionals for HIV treatment (AOR = 1.12, 95% CI 1.00–1.26). These findings underscore the need for innovative solutions to eliminate the practical barriers to HIV services utilization among PLWH who are bisexual, well-educated, and effective HIV-related stigma reduction interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Due to regulations on the confidentiality of data by the Jiangsu Provincial Center for Disease Control and Prevention, the individual information used in this study will not be shared.

References

  1. Grinsztejn B, Hosseinipour MC, Ribaudo HJ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14(4):281–90. https://doi.org/10.1016/s1473-3099(13)70692-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. 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. https://doi.org/10.1056/NEJMoa1105243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. The Joint United Nations Program on HIV/AIDS. Global HIV & AIDS statistics 2021. https://www.unaids.org/en/resources/fact-sheet. Accessed 30 Nov 2023.

  4. Hu X, Zhao Y, Huang L, Luo Y, Wu Z. Antiretroviral treatment discontinuation and its influencing factors among HIV-infected patients who initiated ART from 2012 to 2015 in Wenshan prefecture, Yunnan Province. Zhonghua Yu Fang Yi Xue Za Zhi. 2017;51(11):982–7. https://doi.org/10.3760/cma.j.issn.0253-9624.2017.11.006.

    Article  CAS  PubMed  Google Scholar 

  5. Centres for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data United States and 6 dependent areas, 2020. 2021. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-27-no-3/index.html. Accessed 30 Nov 2023.

  6. Adelekan B, Andrew N, Nta I, et al. Social barriers in accessing care by clients who returned to HIV care after transient loss to follow-up. AIDS Res Ther. 2019;16(1):17. https://doi.org/10.1186/s12981-019-0231-5.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yeung B, Mohd Salleh NA, Socías E, et al. Prevalence and correlates of reporting difficulty taking antiretroviral treatment among HIV-positive illicit drug users in Vancouver, Canada: a longitudinal analysis. AIDS Behav. 2019;23(5):1250–7. https://doi.org/10.1007/s10461-018-2271-6.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zhao DY, Zhang W, Zheng W, Feng YM, Chen HP, Tang H. Antiretroviral therapy and its influencing factors in HIV/AIDS patients in Hubei. China Trop Med. 2022;22(07):656–60.

    Google Scholar 

  9. Dai SY, Liu AW, Jin L, Zhang J, Wu JJ, Wu JB. Survival time and related factors among child HIV/AIDS patients in Anhui province. Chin J Public Health. 2022;38(12):1588–92.

    Google Scholar 

  10. Shi L, Tang W, Hu H, et al. The impact of COVID-19 pandemic on HIV care continuum in Jiangsu, China. BMC Infect Dis. 2021;21(1):768. https://doi.org/10.1186/s12879-021-06490-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Jiangsu Commission of Health. Statutorily notifiable infectious disease epidemics in Jiangsu Province, 2021. 2022. https://wjw.jiangsu.gov.cn/art/2022/5/18/art_49513_10453654.html. Accessed 30 Nov 2023.

  12. Shanghai Municipal People’s Government. Statutorily notifiable infectious disease epidemics in Shanghai, 2021. 2022. https://wsjkw.sh.gov.cn/yqxx/20220426/fba512e3bf7e4eaaa32bd82ef723c4d0.html. Accessed 30 Nov 2023.

  13. Fu T, Wu H, Lu Q, et al. Epidemiological characteristics of notifiable infectious diseases in Zhejiang Province, 2021. Chin J Prev Med. 2022;34(08):842–7. https://doi.org/10.19485/j.cnki.issn2096-5087.2022.08.017.

    Article  Google Scholar 

  14. Wu Z, Fu G, Wen Q, et al. Spatiotemporally comparative analysis of HIV, pulmonary tuberculosis, HIV-pulmonary tuberculosis coinfection in Jiangsu Province, China. Infect Drug Resist. 2023;16:4039–52. https://doi.org/10.2147/idr.S412870.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yuan D, Liu S, Ouyang F, et al. Prevention and control are not a regional matter: a spatial correlation and molecular linkage analysis based on newly reported HIV/AIDS patients in 2021 in Jiangsu, China. Viruses. 2023. https://doi.org/10.3390/v15102053.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Li Q, Wei J, Jiang F, et al. Equity and efficiency of health care resource allocation in Jiangsu Province, China. Int J Equity Health. 2020;19(1):211. https://doi.org/10.1186/s12939-020-01320-2.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zhang Z, Su J, Shen X, et al. Evaluation of the outcome of antiviral therapy among individuals infected HIV-1 in Suqian District of Jiangsu Province, China. Iran J Public Health. 2021;50(8):1586–94. https://doi.org/10.18502/ijph.v50i8.6804.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jaafari Z, McFarland W, Eybpoosh S, et al. Barriers and facilitators of access to HIV prevention, care, and treatment services among people living with HIV in Kerman, Iran: a qualitative study. BMC Health Serv Res. 2022;22(1):1097. https://doi.org/10.1186/s12913-022-08483-4.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kuznetsova AV, Meylakhs AY, Amirkhanian YA, et al. Barriers and facilitators of HIV care engagement: results of a qualitative study in St. Petersburg, Russia. AIDS Behav. 2016;20(10):2433–43. https://doi.org/10.1007/s10461-015-1282-9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Asghari S, Hurd J, Marshall Z, et al. Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis. AIDS Care. 2018;30(8):963–72. https://doi.org/10.1080/09540121.2018.1435848.

    Article  PubMed  Google Scholar 

  21. Taylor BS, Fornos L, Tarbutton J, et al. Improving HIV care engagement in the south from the patient and provider perspective: the role of stigma, social support, and shared decision-making. AIDS Patient Care STDS. 2018;32(9):368–78. https://doi.org/10.1089/apc.2018.0039.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chipanta D, Amo-Agyei S, Giovenco D, Estill J, Keiser O. Socioeconomic inequalities in the 90-90-90 target, among people living with HIV in 12 sub-Saharan African countries—implications for achieving the 95-95-95 target—analysis of population-based surveys. EClinicalMedicine. 2022;53: 101652. https://doi.org/10.1016/j.eclinm.2022.101652.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fauk NK, Mwanri L, Hawke K, Ward PR. Traditional human immunodeficiency virus treatment and family and social influence as barriers to accessing HIV care services in Belu, Indonesia. PLoS ONE. 2022;17(7): e0264462. https://doi.org/10.1371/journal.pone.0264462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Wu Z, Chen J, Scott SR, McGoogan JM. History of the HIV epidemic in China. Curr HIV/AIDS Rep. 2019;16(6):458–66. https://doi.org/10.1007/s11904-019-00471-4.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.

    Article  MathSciNet  CAS  PubMed  Google Scholar 

  26. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. Psychosoc Med. 2012;9:Doc11. https://doi.org/10.3205/psm000089.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Blendon RJ, Schoen C, DesRoches CM, Osborn R, Scoles KL, Zapert K. Inequities in health care: a five-country survey. Health Aff (Millwood). 2002;21(3):182–91. https://doi.org/10.1377/hlthaff.21.3.182.

    Article  PubMed  Google Scholar 

  28. Reinius M, Wettergren L, Wiklander M, Svedhem V, Ekström AM, Eriksson LE. Development of a 12-item short version of the HIV stigma scale. Health Qual Life Outcomes. 2017;15(1):115. https://doi.org/10.1186/s12955-017-0691-z.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Muwanguzi M, Lugobe HM, Ssemwanga E, et al. Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda. BMC Public Health. 2021;21(1):1489. https://doi.org/10.1186/s12889-021-11547-5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. He S, Fang B, Xie X. Temporal and spatial evolution and driving mechanism of urban ecological welfare performance from the perspective of high-quality development: a case study of Jiangsu Province, China. Land. 2022. https://doi.org/10.3390/land11091607.

    Article  Google Scholar 

  31. Wu J, Tang Y. A brief analysis on the predicament of medical security for AIDS patients and its countermeasures in China. Med Jurisprud. 2020;12(01):48–53.

    CAS  Google Scholar 

  32. Ren Y, Zhou Z, Cao D, et al. Did the integrated urban and rural resident basic medical insurance improve benefit equity in China? Value Health. 2022;25(9):1548–58. https://doi.org/10.1016/j.jval.2022.03.007.

    Article  PubMed  Google Scholar 

  33. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52:30–41. https://doi.org/10.1207/s15327752jpa5201_2.

    Article  Google Scholar 

  34. Wang C, Yan S, Jiang H, et al. Socio-demographic characteristics, lifestyles, social support quality and mental health in college students: a cross-sectional study. BMC Public Health. 2022;22(1):1583. https://doi.org/10.1186/s12889-022-14002-1.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zhu Z, Xu Y, Wu S, et al. Survival and risk factors associated with mortality in people living with HIV from 2005 to 2018 in Nanjing, China. Front Public Health. 2022;10: 989127. https://doi.org/10.3389/fpubh.2022.989127.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zhao Y, Han MJ, Gan XM, Ma Y, Zhao DC. Characteristics and viral suppression among people living with HIV from the National Free Antiretroviral Therapy Programme, 2019. HIV Med. 2020;21(11):701–7. https://doi.org/10.1111/hiv.13020.

    Article  CAS  PubMed  Google Scholar 

  37. Folayan MO, Abeldaño Zuñiga RA, Virtanen JI, et al. A multi-country survey on access to healthcare and treatment services among individuals with critical medical care needs during the first wave of the pandemic. BMC Public Health. 2023;23(1):90. https://doi.org/10.1186/s12889-023-15007-0.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Suen YT, Chan RCH, Wong EMY. An exploratory study of factors associated with difficulties in accessing HIV services during the COVID-19 pandemic among Chinese gay and bisexual men in Hong Kong. Int J Infect Dis. 2021;106:358–62. https://doi.org/10.1016/j.ijid.2021.04.005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Chinese Centre for Disease Control and Prevention. Notification to ensure the free HIV antiretroviral drug supply for stranded people living with HIV. 2020. http://www.cqaidsw.com/index.php?m=content&c=index&a=show&catid=58&id=4389. Accessed 30 Nov 2023.

  40. Zhao Y, Han M, Lian Y, et al. A secure supply of antiretroviral medicines for people living with HIV during the COVID-19 pandemic—China’s experience. China CDC Wkly. 2022;4(38):849–52. https://doi.org/10.46234/ccdcw2022.120.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Wang H. HIV care during the coronavirus disease-2019 pandemic in Shenzhen, China. Curr Opin HIV AIDS. 2020;15(6):341–4. https://doi.org/10.1097/coh.0000000000000653.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Xu J, Han M, Jiang Y, et al. Prevention and control of HIV/AIDS in China: lessons from the past three decades. Chin Med J (Engl). 2021;134(23):2799–809. https://doi.org/10.1097/cm9.0000000000001842.

    Article  PubMed  Google Scholar 

  43. Rahman M, Li DH, Moskowitz DA. Comparing the healthcare utilization and engagement in a sample of transgender and cisgender bisexual+ persons. Arch Sex Behav. 2019;48(1):255–60. https://doi.org/10.1007/s10508-018-1164-0.

    Article  PubMed  Google Scholar 

  44. Ross KAE, Law MP, Bell A. Exploring healthcare experiences of transgender individuals. Transgend Health. 2016;1(1):238–49. https://doi.org/10.1089/trgh.2016.0021.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wylie K, Knudson G, Khan SI, Bonierbale M, Watanyusakul S, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. The Lancet. 2016;388(10042):401–11. https://doi.org/10.1016/s0140-6736(16)00682-6.

    Article  Google Scholar 

  46. Johnson MJ, Nemeth LS. Addressing health disparities of lesbian and bisexual women: a grounded theory study. Womens Health Issues. 2014;24(6):635–40. https://doi.org/10.1016/j.whi.2014.08.003.

    Article  PubMed  Google Scholar 

  47. Feinstein BA, Dyar C. Bisexuality, minority stress, and health. Curr Sex Health Rep. 2017;9(1):42–9. https://doi.org/10.1007/s11930-017-0096-3.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Dyar C, Feinstein BA. 6 binegativity: attitudes toward and stereotypes about bisexual individuals. In: Swan DJ, Habibi S, editors. Bisexuality: theories, research, and recommendations for the invisible sexuality. Cham: Springer International Publishing; 2018. p. 95–111.

    Chapter  Google Scholar 

  49. Tromp N, Michels C, Mikkelsen E, Hontelez J, Baltussen R. Equity in utilization of antiretroviral therapy for HIV-infected people in South Africa: a systematic review. Int J Equity Health. 2014;13:60. https://doi.org/10.1186/s12939-014-0060-z.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Rodrigues A, Struchiner CJ, Coelho LE, Veloso VG, Grinsztejn B, Luz PM. Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment. BMC Public Health. 2021;21(1):389. https://doi.org/10.1186/s12889-021-10421-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Lahuerta M, Lima J, Nuwagaba-Biribonwoha H, et al. Factors associated with late antiretroviral therapy initiation among adults in Mozambique. PLoS ONE. 2012;7(5): e37125. https://doi.org/10.1371/journal.pone.0037125.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  52. Nobre N, Pereira M, Roine RP, Sutinen J, Sintonen H. HIV-related self-stigma and health-related quality of life of people living with HIV in Finland. J Assoc Nurses AIDS Care. 2018;29(2):254–65. https://doi.org/10.1016/j.jana.2017.08.006.

    Article  PubMed  Google Scholar 

  53. St Clair-Sullivan N, Mwamba C, Whetham J, Bolton Moore C, Darking M, Vera J. Barriers to HIV care and adherence for young people living with HIV in Zambia and mHealth. mHealth. 2019;5:45. https://doi.org/10.21037/mhealth.2019.09.02.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Ankomah A, Ganle JK, Lartey MY, et al. ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study. BMC Infect Dis. 2016;16(1):738. https://doi.org/10.1186/s12879-016-2075-0.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tomori C, Kennedy CE, Brahmbhatt H, et al. Barriers and facilitators of retention in HIV care and treatment services in Iringa, Tanzania: the importance of socioeconomic and sociocultural factors. AIDS Care. 2014;26(7):907–13. https://doi.org/10.1080/09540121.2013.861574.

    Article  PubMed  Google Scholar 

  56. Xu X, Zhou L, Antwi HA, Chen X. Evaluation of health resource utilization efficiency in community health centers of Jiangsu Province, China. Hum Resour Health. 2018;16(1):13. https://doi.org/10.1186/s12960-018-0275-y.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Jiangsu Provincial People’s Government. From the data to see the new changes in the life of the people in Jiangsu in the past ten years. 2022. http://www.jiangsu.gov.cn/art/2022/9/2/art_88350_10618068.html. Accessed 30 Nov 2023.

Download references

Acknowledgements

We thank all the participants who took part in our study. We would like to thank all the staff of the Centers for Disease Control and healthcare providers at HIV-designated health facilities in the 13 cities in Jiangsu Province for their coordination and data collection.

Funding

This work was supported by the Key Technologies Research and Development Program (2022YFC2304900-4 to WT), National Institute of Health (R34MH119963 and R01AI158826 to WT), National Nature Science Foundation of China (81903371 to WT), and CRDF Global (G-202104-67775 to WT). The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. School of Public Health, Nanjing Medical University, Nanjing, China

    Wei Ai, Dan Wu, Chengxin Fan & Weiming Tang

  2. Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China

    Lingen Shi, Tao Qiu, Yuheng Chen & Gengfeng Fu

  3. University of North Carolina Project-China, Guangzhou, China

    Rayner K. J. Tan, Dan Wu, Gifty Marley, Joseph D. Tucker & Weiming Tang

  4. Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia

    Jason J. Ong

  5. Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

    Jason J. Ong & Joseph D. Tucker

  6. Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China

    Defu Yuan

Authors
  1. Wei Ai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lingen Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rayner K. J. Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason J. Ong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tao Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gifty Marley
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joseph D. Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuheng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Defu Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chengxin Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gengfeng Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Weiming Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WT and GF conceived the initial idea and guided the research project. WA conducted the data collection, analysis and wrote the first draft of the paper. TQ, LS, and YC assisted with the data collection. DY and CF assisted with epidemiological analyses. WT, LS, GF, JDT, JJO, DW, GM, and RJKT contributed to interpreting the results and provided constructive comments on the draft. All co-authors read and approved the final draft as submitted.

Corresponding authors

Correspondence to Gengfeng Fu or Weiming Tang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethical approval was obtained from the ethics review committees at the Jiangsu Provincial CDC ethics review board (IRB Application Number: JSJK2020-B007-02). All participants provided written informed consent before taking part in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ai, W., Shi, L., Tan, R.K.J. et al. HIV Services Uptake Among People Living with HIV in Jiangsu Province, China: A Cross-Sectional Study. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04291-5

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10461-024-04291-5

Keywords

Search

Navigation