published_or_final_version / abstract / Public Administration / Master / Master of Public Administration

Background: The epidemic of HIV among MSM in China shows a hiking trend since 2003. The current intervention strategies in China lack effectiveness to curb the trend. It is imperative to review the interventions for HIV prevention among MSM in other countries to provide evidence for the future intervention design in China. Objectives: This study aimed to review the HIV prevention interventions among men who have sex with men(MSM) in order to identify appropriate intervention strategies and practices to be employed in China. Methods: Studies were searched in Pubmed database. Studies of interventions targeting MSM for HIV prevention among MSM in other countries were included in this systematic review. The search results were also filtered by the study type (i.e. RCT).The results and design of the studies were analyzed and discussed. Results: The studies in this review were analysed in terms of the study design, sampling method, retention and intervention strategies. High risk sexual activity, condom use, HIV testing and HIV knowledge were used as outcome measurements. The findings indicated that the interventions were in general effective in reducing the sexual risk behavior and increasing the intention to have a HIV test. The design of RCT offers stronger evidence of the intervention effects. The intervention strategies combined with internet were more personalized and confidential. Conclusions: Future intervention design in China could consider the strengths of interventions undertaken in other countries in order to improve the effectiveness and sustainability. In consideration of the context of China, this review made some suggestions for more effective implementation of interventions for HIV prevention among MSM in China. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Men who have sex with men (MSM) are a high risk group of human immunodeficiency virus (HIV) infection. Since 2003, HIV prevalence and incidence among MSM in China has increased alarmingly. And then numerous control measures targeting risk reduction of HIV infection among MSM have been implemented. However, previous studies varied in methodologies, prevention or interventions, and most studies only investigated one or several of control measures. Moreover, there are no existing systematic reviews on the effectiveness of integrated control measures against HIV infection. Therefore, this systematic review was conducted to assess the effectiveness of control measures against HIV infection among MSM in China, in terms of condom use, sexual behaviours, awareness of HIV knowledge, HIV counseling and testing, and HIV prevalence and incidence. Methods: A total of 154 articles were first retrieved from English database PubMed, and 114 articles from Chinese database CNKI. 19 English and Chinese articles that met the inclusion criteria were included in this systematically review. Results: The common control measures, including distribution and use of condoms and lubricant, high risk behavioural interventions, education of HIV knowledge, peer interventions, HIV testing and counseling, and MSM community or venue based interventions, are effective in increasing condom use in the anal sex, reducing risk sexual behaviours, improving awareness of HIV knowledge, and promoting the participation of HIV counseling and testing, which are all beneficial to prevent HIV infection among MSM. These findings may be influenced by the design of questions and the standard, and the response of MSM to questions. As for HIV prevalence and incidence, the effectiveness on them is uncertain, probably owing to inappropriate timing of conducting control measures, the short follow-up period, the small sample size or the scale of study. Future studies need to improve sampling method, and extend follow-up time and the study scale appropriately. Conclusion: Based on this systematic review, the control measures are effective in increasing condom use, reducing risk sexual behaviours, improving awareness of HIV knowledge and promoting the participation of HIV counseling and testing, while the effectiveness on HIV prevalence and incidence is uncertain among MSM in China. In future, more policy researches on HIV/AIDS burden, MSM and control measures are needed to provide an evidence base for policy change. In practice, policy makers and researchers need to promote structural control measures targeting different typologies of MSM. And the more effective way in conducting control measures needs the multi-sector cooperation, especially the cooperation between the governmental organizations and MSM community. / published_or_final_version / Public Health / Master / Master of Public Health

Background In the recent decade resurgence of syphilis was noted in a global scale, especially in high-risk communities like men who have sex with men (MSM) and commercial sex workers (CSW). Syphilis co-infection is important in people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) because of their similar transmission routes, mutual interactions at pathophysiology level, relation to socioeconomic factors and public health implications. Methods Retrospective analysis of syphilis co-infections among the HIV/AIDS patients who have been under the care of the AIDS Clinical Service, Queen Elizabeth Hospital of Hong Kong which has served as a tertiary referral center since the beginning of the AIDS epidemic. Details of syphilis co-infection including their clinical stages on diagnosis, evidence of central nervous system (CNS) invasion and recurrence were analyzed. Results In the 1,567 subjects studied 223 (14.2%) had HIV/syphilis co-infection. There are significantly more MSM in the HIV/syphilis co-infected group (P < 0.001). Among the coinfected, 111 (49.8%) had undiagnosed and untreated syphilis at the time of HIV/AIDS diagnosis. Sixty two subjects (27.8%) acquired syphilis as totally new infections after followed up for HIV/AIDS, with a median time of 284.6 weeks (range 3.7-862.3 weeks). Twenty subjects (9.0%) showed evidence of neurosyphilis on cerebrospinal fluid study. Thirty two (14.3%) had recurrent syphilis infections and more than 80% of them occurred in MSM. The total follow up duration was 8616.58 person-years. By Poisson regression, the adjusted total syphilis incidence was 7.07 cases per 100 person-years. MSM had the highest syphilis incidence of 20.25 cases per 100 person-years. In addition syphilis incidence in MSM recruited after the year 2000 was higher than those MSM recruited before. When Comparing subjects with HIV infection diagnosed before 2000 with those having HIV infection diagnosed after 2000, latter have higher cumulative incidence of first syphilis events (P < 0.001). Using Cox regression analysis, MSM (hazard ratio 3.26, 95% CI 1.93 – 5.51, P < 0.0005), bisexual contact (hazard ratio 2.95, 95% CI 1.49 – 5.82, P < 0.005) and infection with HIV-1 subtype B (hazard ratio 1.65, 95% CI 1.08 – 2.53, P = 0.02) were associated with development of first event of syphilis infection during follow up. Conclusions The result of this study corresponded to the global trend of HIV/syphilis syndemic. New and recurrent syphilis infections continued to appear after combination antiretroviral therapy (cART) initiation. MSM, bisexual subjects and infection by HIV-1 subtype B were risk factors for syphilis events. MSM contained the highest syphilis burden. Urgent attention and measures are needed to target syphilis and HIV infection in the Hong Kong MSM population. / published_or_final_version / Public Health / Master / Master of Public Health

Background AIDS as a burden to all over the world caused serious problems in some developing regions by threatening health of the population and stability of the society, especially in cross-border areas that have a complex crowd with many migrants. The HIV/AIDS situation of cross-border FSWs in China-Burma border region is not comprehensively known so far. Only have a clearly understanding of their circumstances, can health workers provide target health services for them. Objectives In view of the increasing HIV epidemic in China-Burma border areas in the past several years, this study tries to understand the HIV prevalence among two groups of cross-border FSWs; further describe socio-demographic characteristics in each group; identify risk behaviours related to consistent condom use; interpret HIV risk factors that contribute to HIV infection in each group of FSWs; describe health services currently being provided and particular health services needs of these FSWs. Methods This cross-sectional research design comprises two parts. Part one is a questionnaire based face-to-face interview to obtain self-reported information. A total of 142 cross-border FSWs were recruited from Ruili City, China (Burmese FSWs) and Laukkai City, Burma (Chinese FSWs). Convenience sampling method was used. Risk factors that mutually adjusted were analysed in two logistic regression models regarding condom use and HIV infection in each group and odds ratios (ORs) were obtained with 95% confidence intervals (CI). Part two of this study is voluntary venous blood drawing and testing for HIV infection. 136 cross-border FSWs [6 of part one (questionnaire interview) participants refused] attended part two study. Results In general, Burmese cross-border FSWs tended to be older, lower educated and married and had higher HIV prevalence (18.8%) compared with Chinese women (5%). Frequency of condom use with the paying clients was higher than with the regular partners in both groups. After adjustment, drug users had statistically significant OR of 6.89 (95% CI: 1.12 to 42.38) for condom use frequency in last sex behaviour compare to non-users in Burmese FSWs; based on Chinese FSWs’ condom use model, the more paying clients, the higher frequency of condom use they had (OR: 0.63 with 95% CI: 0.45 to 0.9). Age (year of birth) had a significant impact with two opposite direction on HIV infection in both Burmese group and the whole study population: positively relate to HIV infection in Burmese model (OR: 1.20 with 95% CI: 1.02 to 1.41); nevertheless, when Chinese ones were added, year of birth negatively related to HIV infection with OR of 0.84 (95% CI: 0.74 to 0.96). Generally, Burmese women had proportionally higher health services acceptance proportion to Chinese women. “HIV/AIDS awareness” and “HIV counselling and testing” were the most widely provided services in Burmese and Chinese group, respectively, and “free condom distribution” was the most needed health services of both cross-border FSWs. Conclusion This study provides better understanding about cross-border FSWs working in China-Burma border areas in which little information about their demographics, HIV infection, and high-risk behaviour has been known. From public health perspective, development and implementation of public health interventions and policies can get inspiration and support from this study. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Architecture / Master / Master of Architecture

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

BACKGROUND The coverage of HIV/AIDS behavioral surveillance among MSM in China falls far short of what is necessary as the current approach is expensive and time consuming. In addition MSM are difficult to reach in China. Internet-based behavioral surveys have demonstrated a number of advantages compared with the traditional paper-pen method. Chinese MSM are avid users of the Internet. Use of the internet provides an opportunity to access this hard-to-reach population and explore their use of the Internet for sexual purposes as well as to assess risk behaviors among MSM internet users. This thesis aimed to explore the trends in risk behaviors and HIV prevalence among MSM using traditional community-based surveys and Internet surveys, and to analyze the potential of web-based behavioral surveillance among MSM by comparing the differences between Internet and community-based MSM samples, and then to provide insights for the future HIV/AIDS behavioral surveillance, epidemic estimation and prediction as well as health intervention among the Chinese MSM population. METHODS This study has three components. The first focuses on trends in HIV risk behaviors and prevalence among MSM in Harbin in northeast China, based on community-based surveys. Eligible participants were approached by peer recruiters in traditional gay venues and then interviewed by health professionals with a standard questionnaire. Urine samples were collected to screen their HIV status. The second part presents two cross-sectional, Internet-based surveys among MSM in China in 2006 and 2007. The study website was advertised on three selected gay websites using a series of banners, pop-ups and text notifications. After providing consent to the survey, eligible participants were invited to complete an online questionnaire. The third component compares the demographic characteristics and risk behaviors of two samples of Chinese MSM. Participants living in Heilongjiang Province were extracted from the 2006 online survey dataset to compare with the community sample of MSM recruited in Harbin, the capital city of Heilongjiang Province in the same year. KEY FINDINGS Community-based behavioral surveillance Among MSM in Harbin, a trend was observed towards more self-identifying as homosexual (from 58% to 80%) and more living with a male partner (from 12% to 41%) over the study period 2002-06. Although there was a trend towards a reduction in the rate of never using a condom and an increase in the rate of always using condoms during anal sex in the past six months, the prevalence of unprotected anal intercourse (UAI) still remained at high level (from 90% in 2002 to 72% in 2006). Most respondents reported having multiple male sexual partners (≥ 2) in the past six months: 86.5% in 2002, 76.0% in 2004 and 91.6% in 2006. The HIV prevalence (2.2%, 15/674) among MSM in Harbin in 2006 was higher than that in previous survey years (1.3% in 2002 and 0.94% in 2004), but no statistically significant change was detected. Internet-based behavioral surveys Gay website users in China are young and well educated. The majority (85%) have used the Internet to seek sex and meeting sexual partners online, which is one of the most common reasons for visiting gay websites. Traditional gay venues still play an important role in the sex seeking process, especially for MSM who are older and less educated. Gay website users are vulnerable to HIV/AIDS given their high prevalence of UAI (56.6%) and multiple male sexual partners (66.5%). The type of partners plays an important role in determining consistent condom use. An increase in condom use was observed among MSM having sex between commercial partners relative to those having sex with non-regular partners and regular partners. Among the Internet sample, participants who have regular partners are less likely to have sex with females, less likely to have multiple partners and less likely to engage in commercial sex behaviors than those who do not. Comparisons between Internet and community samples There are significant differences in terms of demographic characteristics and risk behaviors between the Internet and community samples of MSM. The Internet sample was significantly younger, more educated and more likely to be students and self identify as homosexual. Among those who had anal sex in the past six months, the Internet sample tended to use condoms less consistently than the community sample. However, using the total sample size as the denominator to calculate the prevalence of UAI, no significant difference between the two samples was observed (AOR 1.02, CI 0.73-1.43, p = 0.905). After adjusting for differences in demographic characteristics, the community sample was more likely to have had sex with females (AOR 2.01, CI 1.22-3.30, p = 0.006) and have had ≥ 6 male partners in the previous six months than the Internet sample (46.1% vs. 20.2%; AOR 4.88, CI 3.51-6.80, p < 0.001). The mean number of male partners for the community sample was 13.5 ± 16.8, whereas it was 6.0 ± 12.2 for the Internet sample. CONCLUSIONS Although there is a trend towards an increase in condom use among MSM in China, they are vulnerable to HIV/AIDS infection given their high prevalence of UAI and multiple sexual partners. Public sector officials at all levels need to recognize this risk for HIV transmission. Health promotion and behavioral interventions should be enforced and scaled up to meet the need for controlling HIV transmission among MSM in China. Since the Internet has become a risk environment for MSM and the online MSM population is significantly different from the traditional community MSM group, online MSM should be included as a risk group in national HIV sentinel and behavioral surveillance and the coverage of surveillance for this specific group should be expanded to better understand the health promotion needs of this community as part of an HIV/AIDS strategy in China. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1339648 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

吳木欣. / "2008年7月". / "2008 nian 7 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 169-174). / Abstracts in Chinese and English. / Wu Muxin. / 目錄 / 引言 --- p.9 / Chapter 第一章 --- 文獻回顧 / Chapter 1 --- 何謂 MSM? --- p.11 / Chapter 2 --- 回顧亞洲男男性接觸者感染愛滋病之情況 --- p.11 / Chapter 3 --- 愛滋病感染率急升之原因 --- p.14 / Chapter 3.1 --- 香港同性戀者情況 --- p.17 / Chapter 4 --- 各地政府和NGOs之回應 --- p.19 / Chapter ■ --- 歧視與愛滋病的關連 --- p.20 / Chapter 4.1 --- 美國經驗´ؤ´ؤ活動取向之多元 --- p.21 / Chapter 4.2 --- 亞洲經驗一政府的不支持，非政府組織的無力 --- p.23 / Chapter 5 --- 回顧政府和香港非政府組織(NGOs)的角色 --- p.24 / Chapter 5.1 --- 香港政府採取的措施 --- p.24 / Chapter 5.1.1 --- ACA的建議政策角色 --- p.26 / Chapter 5.1.2 --- ATF的撥款機制角色 --- p.28 / Chapter 5.1.3 --- 非政府組織的工作 --- p.35 / Chapter 6 --- 是次研究的分析框架和概念 --- p.38 / Chapter 7 --- 研究重要之處 --- p.45 / Chapter 第二章 --- 研究方法 --- p.47 / Chapter 第三章 --- 誰是決策者 --- p.52 / Chapter 第四章 --- 主流組織的失敗一一反思一筆過撥款的弊端 --- p.73 / Chapter 第五章 --- 愛滋病非政府組織的無力 --- p.94 / Chapter 第六章 --- 草根組織的掙扎求存 --- p.103 / Chapter 第七章 --- 政府的割裂 --- p.115 / Chapter 第八章 --- 非政府組織的工作---愛滋病只是愛滋病嗎？ --- p.130 / Chapter 第九章 --- 總結 --- p.158 / 參考文獻 --- p.169 / 附件一 --- p.175 / 附件二 --- p.176