Skip to main content

Advertisement

SpringerLink
Log in

HIV Incidence and Care Linkage among MSM First-Time-Testers in Shenyang, China 2012–2014

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

Abstract

HIV testing is the first step to the fulfillment of Treat as Prevention (TasP) and reaching the 90-90-90 goal in HIV control. However, there are still a large number of Men who have Sex with Men (MSM) have never been tested for HIV before, and little is known about the HIV incidence and care linkage among this population. A Mixed method was used to recruit MSM who had never tested for HIV before from January 2012 to December 2014 in Shenyang, China. Potential MSM participants were invited to attend the enrollment for HIV and syphilis testing at a general hospital-based voluntary counseling and test (VCT). HIV confirmed positive subjects were further tested by BED HIV-1 capture enzyme immunoassay (BED-CEIA) to determine the HIV incidence. Syphilis was screened by the rapid plasma reagent test (RPR) and confirmed by Treponema pallidum particle assay (TPPA). All the HIV positive subjects were referred to the local Center for Disease Control and Prevention (CDC) and clinics for HIV primary care and follow-ups. In total 646 HIV first-time-testers of MSM (FMSM) attended this study, 73.4% (474/646) were aged under 31-year-old and 57.3% (370/646) and used the Internet as their major cruising avenue for seeking male sexual partners. The average prevalence of HIV and current syphilis infection was 10.8% (70/646) and 11.0% (71/646), respectively. The HIV incidence was 10.3 (95% confidence interval [CI] 6.1–14.5)/100PY. Multivariate logistic analysis showed that factors such as use of the Internet as the major cruising avenue (adjusted OR [AOR] 2.7, 95% CI 0.9–7.6) and having a current syphilis infection (AOR 4.2, 95% CI 1.8–12.2) were independent correlates of a recent HIV infection. Of the 95 HIV screening test positive FMSM, 73.7% (70/95) returned and be confirmed positive, 92.9% (65/70) of confirmed patients were linked to care. Among those retained and underwent CD4+ T cell test, 76.3% (42/55) started HIV antiretroviral therapy. Among the unconfirmed, 84.0% (21/25) were non-local migrants. The HIV incidence of FMSM in Shenyang was high. Future HIV testing program needs to keep on expanding among the MSM who have never been tested for HIV yet. The Internet-based campaigns and syphilis testing and treatment could represent an opportunity to get access to this hard-to-reach population and link them to HIV care. Future linkage to HIV care of this population should underscore the usage of HIV rapid diagnostic tests to prevent lost at early steps of linkage.

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

References

  1. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infectious Dis. 2011;52(6):793–800.

    Article  Google Scholar 

  3. UNAIDS. AIDS by the numbers 2016. Availabe at http://www.aidsdatahub.org/sites/default/files/highlight-reference/document/UNAIDS_AIDS_by_the_numbers_2016.pdf. Accessed 14 Mar 2017

  4. McLaughlin K. HIV infections are spiking among young gay Chinese. Science. 2017;355(6332):1359.

    Article  CAS  PubMed  Google Scholar 

  5. Zhang BCLX, Shi TX. A primary extimation of the number of population and HIV prevalence in homosexual and bisexual men in China. Chin J AIDS STD. 2002;8(8):197–9.

    Google Scholar 

  6. Zou H, Hu N, Xin Q, Beck J. HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav. 2012;16(7):1717–28.

    Article  PubMed  Google Scholar 

  7. Qin Q, Tang W, Ge L, Li DM, Mahapatra T, Wang LY, et al. Changing trend of HIV, syphilis and Hepatitis C among men who have sex with men in China. Sci Rep. 2016;. doi:10.1038/srep31081.

    Google Scholar 

  8. Bai X, Xu J, Yang J, Yang B, Yu M, Gao Y, et al. HIV prevalence and high-risk sexual behaviours among MSM repeat and first-time testers in China: implications for HIV prevention. J Int AIDS Soc. 2014;17:18848.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liu Y, Qian HZ, Ruan Y, Wu P, Osborn CY, Jia Y, et al. Frequent HIV testing: impact on HIV risk among chinese men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(4):452–61.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gao L, Zhang L, Jin Q. Meta-analysis: prevalence of HIV infection and syphilis among MSM in China. Sex Transm Infect. 2009;85(5):354–8.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zhou Y, Li D, Lu D, Ruan Y, Qi X, Gao G. Prevalence of HIV and syphilis infection among men who have sex with men in China: a meta-analysis. Biomed Res Int. 2014;. doi:10.1155/2014/620431.

    Google Scholar 

  14. Peterman TA, Su J, Bernstein KT, Weinstock H. Syphilis in the United States: on the rise? Expert Rev Anti-Infect Ther. 2015;13(2):161–8.

    Article  CAS  PubMed  Google Scholar 

  15. Pan S, Xu J-J, Han X-X, Zhang J, Hu Q-H, Chu Z-X, et al. Internet-based sex-seeking behavior promotes HIV infection risk: a 6-year serial cross-sectional survey to MSM in Shenyang, China. Biomed Res Int. 2016;. doi:10.1155/2016/2860346.

    Google Scholar 

  16. Communique of the National Bureau of Statistics of People’s Republic of China on Major Figures of the 2010 Population Census. Available at http://www.stats.gov.cn/enGliSH/. Accessed 15 Mar 2017.

  17. Xiao Y, Sun JP, Li CM, Lu F, Allen KL, Vermund SH, et al. Prevalence and correlates of HIV and syphilis infections among men who have sex with men in seven provinces in China with historically low hiv prevalence. JAIDS. 2010;. doi:10.1097/QAI.0b013e3181c7db43.

    PubMed Central  Google Scholar 

  18. Xu JJ, Zhang M, Brown K, Reilly K, Wang HL, Hu QH, et al. Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China. Sex Transmitted Dis. 2010;37(7):432–9.

    Google Scholar 

  19. Yang X, Zhang Y, Wang X, Fang R Gu Y, Tan X (2013) Analysis of characteristics of 936 HIV voluntary testing and counseling visitors in Shenyang. Practical Prevent Med 3.

  20. China Center of Disease Control and Prevention. Update on the AIDS/STD epidemic in China and main response in control and prevention in December, 2015. Chin J AIDS STD. 2016;22(2):69.

    Google Scholar 

  21. Parekh BS, Kennedy MS, Dobbs T, et al. Quantitative detection of increasing HIV type 1 antibodies after seroconversion: a simple assay for detecting recent HIV infection and estimating incidence. AIDS Res Hum Retroviruses. 2002;18(4):295–307.

    Article  CAS  PubMed  Google Scholar 

  22. Hargrove JW, Humphrey JH, Mutasa K, Parekh BS, McDougal JS, Ntozini R. Improved HIV-1 incidence estimates using the BED capture enzyme immunoassay. AIDS (London, England). 2008;22(4):511–8.

    Article  Google Scholar 

  23. Xu J, Wang H, Jiang Y, et al. Application of the BED capture enzyme immunoassay for HIV incidence estimation among female sex workers in Kaiyuan City, China, 2006-2007. Int J Infect Dis. 2010;14(7):e608–12.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Li SW, Zhang XY, Li XX, Wang MJ, Li DL, Ruan YH, et al. Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005–2006. Chin Med J. 2008;121(12):1105–8.

    PubMed  Google Scholar 

  25. Chen Q, Li Y, Su X, Hao M, Lu H, He X. Epidemiological analysis on recent infected HIV-1 patients among newly reported HIV cases in Beijing, from 2009 to 2011. Chin J Epidemiol. 2014;35(1):53–6.

    Google Scholar 

  26. Han M, Feng LG, Yan J, Shen S, Ling H, Ding XB, et al. Surveillance on HIV-1 incidence among men who have sex with men in Chongqing, China, 2006–2008. Chin J Epidemiol. 2009;30(9):878–81.

    Google Scholar 

  27. Center for Disease Control and Prevention. Interim recommendations for the use of the BED capture enzyme immunoassay for incidence estimation and surveillance. Atlanta, GA. 2006. Availabe at https://www.cdc.gov/globalAIDS/docs/surveillance/Interim%20Recommendations%20for%20the%20use%20of%20the%20BED%20capture%20enzyme%20immunoassay%20for%20incidence%20estimation%20and%20surveillance%20Approved%20November%2021%202006%20(2).pdf. Accessed 14 Mar 2017.

  28. UNAIDS (2006) Reference Group on estimates, modelling and projections–statement on the use of the BED assay for the estimation of HIV-1 incidence for surveillance or epidemic monitoring. Weekly Epidemiol Rec 81(4):40.

  29. McFarland W, Busch MP, Kellogg TA, et al. Detection of early HIV infection and estimation of incidence using a sensitive/less-sensitive enzyme immunoassay testing strategy at anonymous counseling and testing sites in San Francisco. JAIDS. 1999;22(5):484–9.

    CAS  PubMed  Google Scholar 

  30. Stall R, Duran L, Wisniewski SR, Friedman MS, Marshal MP, McFarland W, et al. Running in place: implications of HIV incidence estimates among urban men who have sex with men in the United States and other industrialized countries. AIDS Behav. 2009;13(4):615–29.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Li HM, Peng RR, Li J, et al. HIV incidence among men who have sex with men in China: a meta-analysis of published studies. PLoS ONE. 2011;6(8):e23431.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Yang L, Yang C, Jiang Y, Luo H, Chen M, Chen H, et al. The survey on HIV-1 incidence among drug users and men who have sex with men in Yunnan, China. Chin J Dermatovenereol. 2015;29(8):817–9.

    Google Scholar 

  33. Xu JJ, Zhang M, Brown K, et al. Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China. Sex Transm Dis. 2010;37(7):432–9.

    PubMed  PubMed Central  Google Scholar 

  34. Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk: a systematic review. AIDS (London, England). 2014;28(10):1509–19.

    Article  Google Scholar 

  35. Marcus U, Gassowski M, Drewes J. HIV risk perception and testing behaviours among men having sex with men (MSM) reporting potential transmission risks in the previous 12 months from a large online sample of MSM living in Germany. BMC Public Health. 2016;. doi:10.1186/s12889-016-3759-5.

    Google Scholar 

  36. Shang H, Xu J, Han X, Spero Li J, Arledge KC, Zhang L. HIV prevention: bring safe sex to China. Nature. 2012;485(7400):576–7.

    Article  CAS  PubMed  Google Scholar 

  37. Lipsitz MC, Segura ER, Castro JL, Smith E, Medrano C, Clark JL, et al. Bringing testing to the people—benefits of mobile unit HIV/syphilis testing in Lima, Peru, 2007–2009. Int J STD AIDS. 2014;25(5):325–31.

    Article  PubMed  Google Scholar 

  38. Young SD, Cumberland WG, Nianogo R, Menacho LA, Galea JT, Coates T. The HOPE social media intervention for global HIV prevention in Peru: a cluster randomised controlled trial. The lancet HIV. 2015;2(1):e27–32.

    Article  PubMed  Google Scholar 

  39. Swendeman D, Rotheram-Borus MJ. Innovation in sexually transmitted disease and HIV prevention: internet and mobile phone delivery vehicles for global diffusion. Curr Opin Psychiatr. 2010;23(2):139–44.

    Article  Google Scholar 

  40. Liu C, Mao J, Wong T, Tang W, Tso LS, Tang S, et al. Comparing the effectiveness of a crowdsourced video and a social marketing video in promoting condom use among Chinese men who have sex with men: a study protocol. BMJ Open. 2016;6(10):e010755.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Burchell AN, Allen VG, Gardner SL, Moravan V, Tan DH, Grewal R, et al. High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in Ontario, Canada. BMC Infect Dis. 2015;20(15):356.

    Article  Google Scholar 

  42. Jansen K, Thamm M, Bock CT, Scheufele R, Kucherer C, Muenstermann D, et al. High prevalence and high incidence of coinfection with Hepatitis B, Hepatitis C, and syphilis and low rate of effective vaccination against Hepatitis B in HIV-positive men who have sex with men with known date of HIV seroconversion in Germany. PLoS ONE. 2015;10(11):e0142515.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Guidelines for the management of sexually transmitted infections. World Health Organization. 2003.

  44. Bien CH, Muessig KE, Lee R, Lo EJ, Yang LG, Yang B, et al. HIV and syphilis testing preferences among men who have sex with men in South China: a qualitative analysis to inform sexual health services. PLoS ONE. 2015;. doi:10.1371/journal.pone.0124161.

    Google Scholar 

  45. Zhang N, Bussell S, Wang G, Zhu X, Yang X, Huang T, et al. Disparities in HIV care along the path from infection to viral suppression: a cross-sectional study of HIV/AIDS patient records in 2013, Shandong Province, China. Clin Infect Dis. 2016;63(1):115–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Hall HI, Frazier EL, Rhodes P, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Int Med. 2013;173(14):1337–44.

    Article  Google Scholar 

  47. Qin QQ, Guo W, Wang LY, et al. The characteristics of HIV-positive men who have sex with men in China and predictors of their migration, 2008–2015. Chin J Prev Med. 2016;50(11):938–42.

    CAS  Google Scholar 

  48. Parekh BS, Kalou MB, Alemnji G, Ou CY, Gershy-Damet GM, Nkengasong JN. Scaling up HIV rapid testing in developing countries: comprehensive approach for implementing quality assurance. Am J Clin Pathol. 2010;134(4):573–84.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the “Sunshine” NGOs in Shenyang for their help with recruitment of the participants and the Shenyang CDC for profound cooperation in this study. We also thank all of the MSM participants. The study was supported by the Mega-Projects of national science research for the 12th Five-Year Plan (2012ZX10001-006). Thanks to Dr. Ewen MacDonald from University of Eastern Finland for proofreading this manuscript.

Funding

This study was funded by the Mega-Project of National Science Research for the 12th-Five-Year Plan (2012ZX10001-006).

Author information

Author notes

  1. Jing Zhang and Jun-jie Xu have contributed equally to this work.

Authors and Affiliations

  1. Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China

    Jing Zhang, Jun-jie Xu, Shi Pan, Zhen-xing Chu, Qing-hai Hu, Huan Yu, Xiang Mao, Yong-jun Jiang, Wen-qing Geng, Hong Shang & Ning Wang

  2. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China

    Jing Zhang, Jun-jie Xu, Shi Pan, Zhen-xing Chu, Qing-hai Hu, Huan Yu, Xiang Mao, Yong-jun Jiang & Wen-qing Geng

  3. Shenyang Center for Disease Control and Prevention, No. 37, Qishanzhong Street, Heping District, Shenyang, Liaoning, China

    Wei Song

  4. National Center for AIDS/STI Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, China

    Ning Wang

Authors
  1. Jing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun-jie Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shi Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhen-xing Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qing-hai Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Huan Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiang Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yong-jun Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wen-qing Geng
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hong Shang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ning Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceived and designed the experiments: JJX, JZ; performed the study and experiments: JZ, SP, HY, XM, ZXC, QHH; analyzed the data: JZ, JJX; contributed reagents/materials/analysis tools: YJJ, WQG; interpretation of data and study findings: JZ, JJX, WS; drafted the study report: JZ, JJX, NW, HS. All authors reviewed and approved the final report.

Corresponding authors

Correspondence to Hong Shang or Ning Wang.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, J., Xu, Jj., Song, W. et al. HIV Incidence and Care Linkage among MSM First-Time-Testers in Shenyang, China 2012–2014. AIDS Behav 22, 711–721 (2018). https://doi.org/10.1007/s10461-017-1840-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-017-1840-4

Keywords

Search

Navigation