HIV Incidence and Associated Factors in a Cohort of Men Who Have Sex With Men in Nanjing, China

Background: Many surveys conducted in recent years reported the increasing trend of HIV infection among men who have sex with men (MSM), but limited data exists on HIV incidence by cohort study in China. Methods: A 6-month prospective cohort study was conducted. A total of 397 MSM found HIV seronegative at baseline study were followed-up for 6 months starting from May 2007 and re-evaluated seroconversions of HIV at 6 months. Questionnaire interviews were conducted to collect information about risk behaviors. Results: Of the 397 MSM who were found seronegative at the baseline study, 286 (72.0%) received the HIV antibody testing at month 6; 7 of them showed HIV seroconversions, yielding an incidence of 5.12 per 100 person-years. Significant predictors of seroconversion (Poisson regression analyses) included duration being MSM >10 years (relative risks [RR] = 3.08, 95% CI: 1.53–6.20), recruiting male sex partner mostly at saunas (RR = 2.35, 95% CI:1.09–5.08), positive syphilis diagnosis made at the baseline study (RR = 2.82, 95% CI: 1.31–6.09), having multiple male sex partners in the last 6 months (RR = 2.54, 95% CI: 1.18–5.49), having at least 1 casual male sex partner in the last 6 months (RR = 2.17, 95% CI: 1.00–4.70), and having unprotected anal sex with a regular male sex partner in the last 6 months (RR = 2.22, 95% CI: 1.10–4.49). Conclusions: The incidence of HIV among MSM is very high; many new infections would hence occur in China. Effective interventions are warranted. The risk factors reported in this study give some insights for designing relevant prevention programs.

[1]  Jinkou Zhao,et al.  High HIV Prevalence Detected in 2006 and 2007 Among Men Who Have Sex With Men in China's Largest Municipality: An Alarming Epidemic in Chongqing, China , 2009, Journal of acquired immune deficiency syndromes.

[2]  S. Tsui,et al.  Rapidly Increasing Prevalence of HIV and Syphilis and HIV-1 Subtype Characterization Among Men Who Have Sex With Men in Jiangsu, China , 2009, Sexually transmitted diseases.

[3]  T. Feng,et al.  Prevalence of syphilis and HIV infections among men who have sex with men from different settings in Shenzhen, China: implications for HIV/STD surveillance , 2008, Sexually Transmitted Infections.

[4]  Guozhang Xu,et al.  The characterisation of sexual behaviour in Chinese male university students who have sex with other men: A cross-sectional study , 2008, BMC public health.

[5]  J. Kaldor,et al.  Trend in HIV incidence in a cohort of homosexual men in Sydney: data from the Health in Men Study. , 2008, Sexual health.

[6]  Y. Ruan,et al.  Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005 - 2006. , 2008, Chinese medical journal.

[7]  Wayne T. Steward,et al.  Social Discrimination, Concurrent Sexual Partnerships, and HIV Risk Among Men Who have Sex with Men in Shanghai, China , 2008, AIDS and Behavior.

[8]  Ning Wang,et al.  Prevalence of Bisexual Behaviors Among Men Who Have Sex With Men (MSM) in China and Associations Between Condom Use in MSM and Heterosexual Behaviors , 2008, Sexually transmitted diseases.

[9]  W. Steward,et al.  Assessment of Stigma Towards Homosexuality in China: A Study of Men Who Have Sex with Men , 2008, Archives of sexual behavior.

[10]  W. Mcfarland,et al.  HIV Prevalence and Correlates of Unprotected Anal Intercourse Among Men Who Have Sex with Men, Jinan, China , 2008, AIDS and Behavior.

[11]  N. He,et al.  HIV risks among gay- and non-gay-identified migrant money boys in Shanghai, China , 2008, AIDS care.

[12]  M. Alary,et al.  Determinants of HIV Seroconversion Among Men Who Have Sex With Men Living in a Low HIV Incidence Population in the Era of Highly Active Antiretroviral Therapies , 2008, Sexually transmitted diseases.

[13]  Ning Wang,et al.  The development of HIV/AIDS surveillance in China. , 2007, AIDS.

[14]  Min Xu,et al.  Trends in Prevalence of HIV, Syphilis, Hepatitis C, Hepatitis B, and Sexual Risk Behavior Among Men Who Have Sex With Men: Results of 3 Consecutive Respondent-Driven Sampling Surveys in Beijing, 2004 Through 2006 , 2007, Journal of acquired immune deficiency syndromes.

[15]  H. Xing,et al.  Relationship Between Syphilis and HIV Infections Among Men Who Have Sex With Men in Beijing, China , 2007, Sexually transmitted diseases.

[16]  S. Gregorich,et al.  The Influence of Social and Sexual Networks in the Spread of HIV and Syphilis Among Men Who Have Sex With Men in Shanghai, China , 2007, Journal of acquired immune deficiency syndromes.

[17]  G. Kok,et al.  Sexual Decision-Making in HIV-Positive Men Who Have Sex with Men: How Moral Concerns and Sexual Motives Guide Intended Condom Use with Steady and Casual Sex Partners , 2007, Archives of sexual behavior.

[18]  Yu Wang,et al.  Evolution of China's response to HIV/AIDS , 2007, The Lancet.

[19]  Ronald B Geskus,et al.  HIV incidence and HIV testing behavior in men who have sex with men: using three incidence sources, The Netherlands, 1984–2005 , 2007, AIDS.

[20]  Dimitri Prybylski,et al.  Application of Respondent Driven Sampling to Collect Baseline Data on FSWs and MSM for HIV Risk Reduction Interventions in Two Urban Centres in Papua New Guinea , 2006, Journal of Urban Health.

[21]  I. Hurtado,et al.  Trends in HIV testing, serial HIV prevalence and HIV incidence among people attending a Center for AIDS Prevention from 1988 to 2003 , 2006, Sexually Transmitted Infections.

[22]  R. Bollinger,et al.  High rates of syphilis among STI patients are contributing to the spread of HIV-1 in India , 2006, Sexually Transmitted Infections.

[23]  J. D. de Wit,et al.  Incidence of Sexually Transmitted Diseases and HIV Infection in Men Who Have Sex With Men Related to Knowledge, Perceived Susceptibility, and Perceived Severity of Sexually Transmitted Diseases and HIV Infection: Dutch MSM–Cohort Study , 2006, Sexually transmitted diseases.

[24]  B. Stanton,et al.  Men Who Have Sex With Men and Human Immunodeficiency Virus/Sexually Transmitted Disease Control in China , 2006, Sexually transmitted diseases.

[25]  Q. Xia,et al.  High Prevalence of Sexually Transmitted Diseases Among Men Who Have Sex With Men in Jiangsu Province, China , 2006, Sexually transmitted diseases.

[26]  Bei-chuan Zhang,et al.  MSM and HIV/AIDS in China , 2005, Cell Research.

[27]  E. Vittinghoff,et al.  Sexual Risk, Nitrite Inhalant Use, and Lack of Circumcision Associated With HIV Seroconversion in Men Who Have Sex With Men in the United States , 2005, Journal of acquired immune deficiency syndromes.

[28]  I. Stolte,et al.  Increase of sexually transmitted infections, but not HIV, among young homosexual men in Amsterdam: are STIs still reliable markers for HIV transmission? , 2005, Sexually Transmitted Infections.

[29]  J. Mandel,et al.  High HIV Risk but Inadequate Prevention Services for Men in China Who Have Sex with Men: An Ethnographic Study , 2002, AIDS and Behavior.

[30]  D. Heckathorn,et al.  Extensions of Respondent-Driven Sampling: A New Approach to the Study of Injection Drug Users Aged 18–25 , 2002, AIDS and Behavior.

[31]  Douglas D. Heckathorn,et al.  Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hi , 2002 .

[32]  R. Janssen,et al.  HIV incidence among young men who have sex with men--seven U.S. cities, 1994-2000. , 2001, MMWR. Morbidity and mortality weekly report.

[33]  J. Elford,et al.  Sexual risk behaviour among gay men in a relationship. , 1999, AIDS.

[34]  Douglas D. Heckathorn,et al.  Respondent-driven sampling : A new approach to the study of hidden populations , 1997 .

[35]  J. Kaldor,et al.  Preparation for Phase III HIV vaccine efficacy trials: methods for the determination of HIV incidence , 1994, AIDS.