High prevalence of syphilis and overlapped unprotected commercial sex and drug using behaviors among FSWs along a drug-trafficking route may suggest a potential for rapid spread of HIV from injection drug users to FSWs and then to the general population and underscore the urgency of preventive interventions to break the bridge of FSWs for HIV/sexually transmitted disease spread.

High mobility, multiple sexual partners, and high prevalence of unprotected sex behaviors and syphilis infection suggest a potential rapid spread of HIV in Chinese MSM.

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.

Objective Female injection drug users who are also sex workers (FSW-IDUs) occupy a pivotal population in HIV transmission, whereas their mental health problems are largely overlooked. We aimed to investigate prevalence and associated socio-ecological factors of depression, suicidal ideation and suicidal attempts among FSW-IDUs in China. Methods Using snowball sampling methods, 200 FSW-IDUs were recruited from communities in Liuzhou, China. Anonymous face-to-face interviews were administered by trained doctors. Results Thirty-nine percent of participants had severe or extremely severe depression, 44.7% had suicidal ideation in the last six months and 26.8% had suicidal attempts in the last six months. After adjusting for background variables, self-stigma was significantly associated with severe or extremely severe depression (OR=1.18, 95% CI: 1.07–1.31). Self-stigma (OR=1.08, 95% CI: 1.01–1.15), depression (OR=1.11, 95% CI: 1.05–1.18), having completely broken up with family (OR=2.60, 95% CI: 1.35–5.02) and having been abused by clients or gatekeepers (OR=2.15, 95% CI: 1.32–3.50) were associated with suicidal ideation in the last six months, while self-stigma (OR=1.03, 95% CI: 1.10–1.16), depression (OR=1.12, 95% CI: 1.04–1.20) and being abused by clients or gatekeepers (OR=2.15, 95% CI: 1.09–4.24) were associated with suicidal attempt in the last six months. In mediation analyses, the associations between self-stigma and the two suicidal outcomes were fully mediated by depression. Conclusions There are unmet mental health needs of FSW-IDUs. Screening of mental health problems should be integrated into current HIV-related services. Psychological intervention efforts should include components such as self-stigma, family support and abuse.

The randomized controlled trial investigated the relative efficacy of an enhanced (EVCT) versus standard (SVCT) voluntary counseling and testing in reducing unprotected anal intercourse (UAI) among men who have sex with men (MSM) in China. 295 participants who recruited by respondent driven sampling methods were randomly allocated to the two arms. In addition to the SVCT, the EVCT group watched a theory-based video narrated by a HIV positive MSM, received enhanced counseling and a reminder gift. As compared to the SVCT group, the EVCT group reported lower prevalence of UAI with any male sex partners (48.4% versus 66.7%, RR = 0.7, ARR = -18.3%, p = 0.010) and with regular male sex partners (52.2% versus 68.9%, RR = 0.8, ARR = -16.7%, p = 0.043) at Month 6, whilst baseline between-group differences were statistically non-significant. Between-group differences in HIV/syphilis incidence were statistically non-significant. Translational research should be conducted to integrate non-intensive enhancements such as the EVCT into regular testing services.