HIV/AIDS epidemic among older adults in China during 2005-2012: results from trend and spatial analysis.

BACKGROUND: Recent studies have indicated an increasing burden of human immunodeficiency virus (HIV)/AIDS among older adults. METHODS: All identified people living with HIV/AIDS (PLWHA) recorded through the Chinese HIV/AIDS CRS during 2005-2012 were included in the study, except for the cases that lacked specific spatial information. Trend tests and spatial analyses were conducted. RESULTS: Information about 73,521 PLWHA (aged ≥50 years) was collected during 2005-2012. Three provinces-Guangxi, Henan, and Yunnan-accounted for 54.4% of the identified cases during the study period. Compared with 2005, the ratio between residents and migrants among the study population decreased to 40.1% in 2012. The ratio of HIV-infected patients to AIDS patients and the ratio of males to females increased gradually among older infected adults. Results of spatial analysis indicate a clustered distribution of HIV/AIDS among older adults throughout the country. Hot spots were observed in 4 provinces (Guangxi, Henan, Yunnan, and Sichuan) and 1 municipality (Chongqing). A trend from central provinces toward southern provinces was also identified. CONCLUSIONS: The number and proportion of HIV/AIDS among older adults have increased in recent years. The hot spots showed movement from central to southern China. A focused intervention strategy targeting the older PLWHA is urgently required in China.

The HIV, syphilis, and HCV epidemics among female sex workers in china: results from a serial cross-sectional study between 2008 and 2012.

BACKGROUND: Studies on the transmission of human immunodeficiency virus (HIV) and sexually transmitted diseases in female sex workers (FSWs) have been limited primarily to inferences drawn by focusing on defined geographical areas. METHODS AND FINDINGS: This serial cross-sectional study was conducted in mainland China from 2008 through 2012. Data for 827 079 participants was analyzed. We classified venues such as karaoke bars and hotels as high tier and venues such as hair salons and barbershops, massage parlors, and other public outdoor venues as low tier based on the participants' socioeconomic status. FSWs who worked at the venues and those who were present on the days of the survey were recruited. The prevalence of HIV decreased from 0.6% in 2008 to 0.3% in 2012, the syphilis prevalence ranged from 2.4% to 3.2% between 2008 and 2012, and hepatitis C virus (HCV) prevalence decreased from 0.9% in 2008 to 0.8% in 2012. Further, we found that HIV, syphilis, and HCV prevalence proportions were high in FSWs from low tiers. CONCLUSIONS: HIV, syphilis, and HCV prevalence among FSWs in our study decreased during the study period. Comprehensive intervention strategies, particularly those that focus on low-tier and older FSWs, are needed in order to decrease the disease burden in this population.

Effectiveness of ART and condom use for prevention of sexual HIV transmission in serodiscordant couples: a systematic review and meta-analysis.

BACKGROUND: Consistent and correct condom use and suppressive antiretroviral therapy for the infected partner are two of the primary strategies recommended for prevention of heterosexual HIV transmission in serodiscordant couples today. The applied effectiveness of treatment as a prevention strategy in China is still under investigation, and much less is known about its effects in the presence of other prevention strategies such as consistent condom use. METHODS: We conducted a systematic search in PubMed and three Chinese language databases to identify relevant articles for the estimation of relative effectiveness of a) consistent condom use and b) ART use by index partners for preventing HIV transmission in serodiscordant couples. We also estimated the prevention effectiveness of ART stratified by condom use level and the prevention effectiveness of consistent condom use stratified by ART use level. RESULTS: Pooled results from the eleven eligible studies found a pooled HIV seroconversion incidence of 0.92 cases per 100 person years (PY) among HIV-negative spouses whose index partners were taking ART versus 2.45 cases per 100 PY in untreated couples. The IRR comparing seroconversion in couples where the index-partner was on ART versus not on ART was 0.47 (95%CI: 0.43, 0.52), while stratified by condom use, the IRR was 0.33(0.17,0.64). The IRR comparing incidence in couples reporting "consistent condom use" versus those reporting otherwise was 0.02(95%CI:0.01,0.04), after stratified by ART use level, the IRR was 0.01(95%CI: 0.00, 0.06). CONCLUSIONS: ART use by index partners could reduce HIV transmission in serodiscordant couples, and the effectiveness of this prevention strategy could be further increased with consistent condom use.

Diversity of HIV/AIDS epidemic in China: a result from hierarchical clustering analysis and spatial autocorrelation analysis.

OBJECTIVE: To find out the diversity of HIV/AIDS epidemic among different areas in China according to their varied epidemic characteristics. DESIGN AND METHODS: Seventeen provincial variables, generated from original HIV/AIDS epidemic data and socioeconomic indicators to indicate HIV/AIDS epidemic characteristics, were introduced to hierarchical clustering analysis to form subepidemic areas. Then spatial autocorrelation analysis was applied to show the clustering distribution of cases from different most-at-risk populations. RESULTS: Three HIV/AIDS subepidemic areas (A, B, C) were formed, each of which was further divided into two clusters, showing the diversity of HIV/AIDS epidemic in China. A1 was the earliest and severest HIV/AIDS epidemic area and occupied 37% hotspot counties. The epidemic in A1 was driven by IDU in its early period and heterosexual transmission later. Henan, the only province in A2, characterized by its HIV/AIDS epidemic among former plasma donors during the early 1990s, presented strong spatial clustering of blood/plasma transmission occupying 80% blood/plasma hotspots. The epidemic within B3, located in southwest China, was driven by IDU and heterosexual populations, and recently by MSM. The epidemic within B4, covering all four municipalities, had been largely spread among MSM since 2005. B3 and B4 occupied 76% MSM hotspots. For C5 and C6, only sporadic HIV/AIDS infections occurred in the last years among former plasma donors and heterosexual populations, whereas the prevalence among MSM had been increasing. CONCLUSION: China's different HIV/AIDS subepidemic areas had obvious diversity of affected populations, which should be considered when determining prevention policies.

[Spatial analysis on the HIV/AIDS infection status among injecting drug users in China, from 2005 to 2011].

OBJECTIVE: To analyze the spatial distribution of HIV/AIDS epidemics among injecting drug users(IDUs) in China from 2005 to 2011 and to understand its changing trend. METHODS: Using data on people living with HIV and AIDS through injecting drug between 2005 and 2011 to analyze the demographic characteristics of injecting drug users. Analysis on spatial correlation (provincial level and country level) and median center of hot spots(country level)were conducted by Arcgis software. RESULTS: Sex ratio (male/female) and registered place ratio(province/other provinces)reduced as time went by, with the ratios in 2011 as 6.75 and 7.01 respectively. Tape ratio of the disease between HIV and AIDS showed an upward trend (Z = 26.880, P < 0.01). Since 2005, the identified numbers of HIV/AIDS and the spatial correlation and hot spots in provincial level had reduced, the numbers of provincial hot spots were two from 2009 to 2011(Sichuan and Yunnan provinces)at the national level. However, the spatial correlation and hot spots at the provincial level had an increasing trend. Between 2005 and 2011, the Western Median Centers of hot spots was located in Xinjiang province while the Southwestern Median Center of hot spots tended to move towards the north. CONCLUSION: The demographics changes of HIV/AIDS infection among injecting drug users seemed to be regular from 2005 to 2011. Spatial correlation at the provincial level was reducing. However, the spatial correlation and the numbers of hot spots at the country level increased, with hot spots at the country level tended to move from the border areas towards inland.

Spatial analysis on hepatitis C virus infection in mainland China: from 2005 to 2011.

BACKGROUND: The burden of Hepatitis C virus (HCV) has become more and more considerable in China. A macroscopic spatial analysis of HCV infection that can provide scientific information for further intervention and disease control is lacking. METHODS: All geo-referenced HCV cases that had been recorded by the China Information System for Disease Control and Prevention (CISDCP) during 2005-2011 were included in the study. In order to learn about the changes of demographic characteristics and geographic distribution, trend test and spatial analysis were conducted to reflect the changing pattern of HCV infection. RESULTS: Over 770,000 identified HCV infection cases had specific geographic information during the study period (2005-2011). Ratios of gender (Male/Female, Z-value  = -18.53, P<0.001), age group (≤30 years old/≥31 years old, Z-value  = -51.03, P<0.001) and diagnosis type (Clinical diagnosis/Laboratory diagnosis, Z-value  = -130.47, P<0.001) declined. HCV infection was not distributed randomly. Provinces Henan, Guangdong, Guangxi, Xinjiang, and Jilin reported more than 40,000 HCV infections during 2005 to 2011, accounting for 43.91% of all cases. The strength of cluster of disease was increasing in China during the study period. Overall, 11 provinces had once been detected as hotspots during 7 years, most of which were located in the central or border parts of China. Tibet, Qinghai, Jiangxi were the regions that had coldspots. CONCLUSIONS: The number of clustering of HCV infection among older adults increased in recent years. Specific interventions and prevention programs targeting at main HCV epidemic areas are urgently in need in mainland China.