HIV and syphilis prevalences among MSM in China are high and the 2 epidemics are largely separate geographically. Three segments of the Chinese MSM population each have different demographic and sexual risk "profiles" that suggest high potential for bridging infection across geographies, generations, and sexes.

Stigma is a significant barrier to effective control of HIV/AIDS, despite laws to control it. The purpose of this study was to examine factors associated with HIV stigma in a rural Chinese community. A survey was conducted in north-west Anhui province among 963 residents to assess HIV-related knowledge, attitudes, and behaviors. Participants scored a mean of 16.6/26 (63.8%) for knowledge. Sixty-eight percent of respondents held at least one fear of casual transmission, 42% would blame people living with HIV/AIDS (PLHA) for their disease, and 73% thought having HIV is shameful. More than half reported that they had observed at least one stigmatizing behavior toward PLHA in their villages. Multivariable analysis indicated that people with higher education, higher HIV knowledge, higher household wealth and who learned about HIV from professional sources were less likely to hold a stigmatizing attitude, while people who had observed discriminating behaviors toward PLHA in their community and lived in villages with fewer PLHA were more likely to hold a stigmatizing attitude. Despite education campaigns, knowledge remains low and stigmatizing attitudes and behaviors toward PLHA remain a problem.

ObjectivesTo assess HIV incidence and its associated risk factors among young men who have sex with men (YMSM) in urban areas, China.DesignThe study used a prospective cohort study design and standard diagnostic tests.MethodsA twelve-month prospective cohort study was conducted among YMSM (18–25 years old) in 8 large cities in China. The participants were recruited via snowball sampling. A total of 1102 HIV-negative YMSM completed baseline assessment, 878 YMSM participants completed 6-month follow-up, and 902 completed 12-month follow-up. HIV was screened by an enzyme-linked immunosorbent assay and confirmed with Western Blot. Syphilis was screened via rapid plasma reagent and confirmed by treponema pallidum particle agglutination assay.Results78 HIV seroconversions were identified within 1168.4 person-year observations yielding an incidence rate of 6.7 per 100 person-years. HIV seroconversion was associated with non-student status (RR = 2.61, 90% CI = 1.3–5.26), low HIV transmission knowledge (RR = 8.87, 90% CI = 2.16–36.43), and syphilis infection (RR = 5.04, 90% CI = 2.57–9.90).ConclusionsIncidence of HIV among YMSM is high in urban areas of China. Interventions measures are required to contain the HIV epidemic within this population.

China is experiencing an emerging HIV epidemic, primarily affecting the rural poor. For this group, the costs of staying healthy are often beyond their means. A qualitative study was undertaken with 20 HIV-positive people living in a rural area in Anhui, eastern China, 20 of their family members, 20 health care providers, and 20 uninfected villagers. In this area, the majority of HIV-positive people were infected through contaminated commercial plasma/blood donation procedures. In-depth interviews were conducted with participants to identify the barriers and enablers to accessing health care services for HIV. A major concern for affected villagers was the unaffordable costs of health care, which leads them to delay seeking services until symptoms are severe. Use of the health care system was also influenced by the availability of subsidized medications, distance to the health care centre and quality of available services. In contrast, participants were very positive about antiretroviral treatment services, which are now free. In the study area, access to health care is heavily subsidized, yet many still found these services unaffordable. More equitable and affordable services will be needed if China is to control its HIV epidemic.

BackgroundVarious studies have modeled the impact of test-and-treat policies on the HIV epidemics worldwide. However, few modeling studies have taken into account China’s context. To understand the potential effect of test-and-treat on the HIV epidemic among men who have sex with men (MSM) in China, we developed a mathematical model to evaluate the impact of the strategy.MethodBased on the natural history of the CD4 count of people living with HIV and AIDS (PLWHA), we constructed a dynamic compartmental model of HIV transmission among Chinese MSM to project the number of HIV new infections and prevalence over 10 years. We predicted the annual number of HIV new infections and the total number of MSM living with HIV and AIDS (based on Beijing data) between 2010 and 2022 under the following conditions: (1) current practice (testing rate of 50% and ART coverage of 39%); (2) both testing rate and ART coverage increasing to 70% in 2013; (3) both testing rate and ART coverage increasing to 90% in 2013; and (4) both testing rate and ART coverage increasing gradually every year until 90% since 2013.ResultsBased on our model, if the HIV test-and-treat policy was implemented among Chinese MSM, the total number of HIV new infections over 10 years (2013-2022) would be reduced by 50.6-70.9% compared with the current policy. When ART coverage for PLWHA increased to 58% since 2013, the ‘turning point’ would occur on the curve of HIV new infections by 2015. A 25% reduction in annual number of HIV new infections by 2015 might be achieved if the testing rate increased from 50% to 70% and treatment coverage for PLWHA increased to 55% since 2013.ConclusionImplementation of the test-and-treat strategy may significantly reduce HIV new infections among MSM in China. Great efforts need to be made to scale up HIV testing rate and ART coverage among Chinese MSM.