Bridging the Epidemic: A Comprehensive Analysis of Prevalence and Correlates of HIV, Hepatitis C, and Syphilis, and Infection among Female Sex Workers in Guangxi Province, China

Abstract

IntroductionFemale sex workers (FSWs) are at highest risk for contracting HIV and facilitating the current heterosexual HIV epidemic in Guangxi, China, yet little is known of the impact of recent harm reduction campaigns in the province. We analyzed sentinel surveillance data collected between 2010 and 2012 in Guangxi to explore correlations between the prevalence of HIV, hepatitis C (HCV), and syphilis and risk behaviors of different categories of FSWs in Guangxi.MethodsThe sentinel surveillance data for 5,1790 FSWs in all 14 prefectures and 64 city/county regions of Guangxi, China from 2010 to 2012 were collected. Differences between three categories of FSWs (grouped by venue) and disease trends (HIV, HCV, and syphilis) by year were analyzed using bivariate and multivariate logistic regression analyses as to evaluate risk factors correlated with HIV, HCV, or syphilis infection.ResultsHIV and HCV prevalence remained constant across the three FSW categories; however, syphilis prevalence showed a significant increase from 5.7% to 7.3% for low-tier FSWs. Most cases with HIV, HCV, syphilis and intravenous drug use were seen in low-tier FSWs. Testing positive for HIV and syphilis were most correlated with being HCV positive (AOR 4.12 and AOR 4.36), only completing elementary school (AOR 3.71 and AOR 2.35), low tier venues (AOR 2.02 and AOR 2.00), and prior STI (AOR 1.40 and AOR 3.56), respectively. HCV infection was correlated with ever injecting drugs (AOR 60.65) and testing positive for syphilis (AOR 4.16) or HIV (AOR 3.74).ConclusionsThis study highlights that low tier FSWs with lower formal education levels are the most vulnerable population at risk for acquiring and transmitting HIV, HCV, and syphilis in Guangxi, China. Condom distribution with evolution to safer sex practices are the reasons to explain the non-increasing prevalence of HIV, HCV in Guangxi for 2010–2012.

No Difference in Prevalence of Transmitted Drug Resistance between Injection Drug Users and Non-Injection Drug Users: A Cross-Sectional Study among Antiretroviral Treatment-Naïve HIV Patients

“…Guangxi is located along the illicit drug trafficking route from the “Golden Triangle” to China and has the second highest reported number of HIV/AIDS cases (over 100,000 cases by the end of 2016) in China. Consistent with other areas in China, a significant increase in HIV infection through heterosexual contact has been observed in Guangxi [29]. Lingshan County, a rural prefecture in southern Guangxi (online suppl.…”

Who to test and how to test for chronic hepatitis C infection – 2016 WHO testing guidance for low- and middle-income countries

“…WHO recommended the use of two main potential testing approaches for HCV infection: focused testing in most affected populations; and birth cohort testing, based on consideration of limited evidence including various systematic reviews on seroprevalence rates in different populations and regions [35][36][37][38][39][40], and a review of costeffectiveness studies of different HCV testing approaches [39,, as well as of programmatic feasibility from reported experience in countries using these approaches [34].…”

“…Table 3. Different types of HCV epidemic patterns [18,34] with corresponding testing approaches and service delivery models [35][36][37][38].…”

“…HCV prevalence is nearly universally high among PWID (ranging from 30% to 75% in cohorts in North America, Europe, and Asia [35], and in many high-income countries, active injecting drug use drives ongoing HCV transmission. MSMs (especially those who are HIV infected [36], commercial sex workers and prisoners related to both drug use and perhaps sexual transmission) [37,38], also have increased prevalence.…”

Hepatitis C virus infection in the general population: A large community-based study in Mianyang, West China

“…The prevalence of HCV infection ranged from 0.43% to 3.2%, and varied geographically and temporally in China (7)(8)(9). During the past decades, most of studies related to HCV infection in China focused on hospital based and high risk population groups including blood donors and receivers, drug abusers, individuals with HIV, and sex workers (10)(11)(12)(13); while there were only a few large-scale studies in China which concentrated on HCV prevalence in the general population (8,9,14).…”