Treatment of upper eyelid third-degree burns by dispersed implantation of very small autologous columnar skin grafts: A pilot study of a new method.

OBJECTIVE: This retrospective study compared the effectiveness of dispersed implantation of very small autologous columnar skin (SCS) grafts and full-thickness skin grafts (FTSGs) for treating upper eyelid third-degree burns. METHODS: Fourteen patients and 26 eyes with granulation tissue formed by third-degree upper eyelid burns were enrolled in the study from August 2017 to June 2020. The experimental group of 6 patients with 11 eyes was treated with SCS grafts. The control group of 8 patients with 15 eyes was treated with FTSGs. The survival rate of the grafts, healing time, SCS diameter, upper eyelid movement distance (ULMD), visual analogue scale (VAS) score for patient satisfaction, and Vancouver Scar Scale (VSS) score were evaluated. RESULTS: The difference in the survival rate between the two groups was not statistically significant (P = 0.06). The ULMD and VAS scores in the experimental group were higher than those in the control group (P < 0.05). The healing time was longer in the experimental group than in the control group (P < 0.05). The VSS scores of the donor site and the skin grafting site in the experimental group were lower than those in the control group (P < 0.05). CONCLUSION: Unlike classical skin grafts, SCS implantation surgery can restore the appearance of the upper eyelid, and there is no obvious scar at the donor site. This can be a viable alternative to traditional FTSGs with potential benefits.

[Influencing factors for loss to follow-up in a longitudinal study on HIV incidence of female sex workers].

OBJECTIVE: To study the loss to follow-up (LTF) rate, HIV emerging incidence and influencing factors in the longitudinal study of female sex workers (FSWs) in Kaiyuan, Yunnan, and their influence on HIV emerging incidence estimate. METHODS: The open cohort study on FSWs was launched in March 2006 and ended in June 2013 in Kaiyuan, Yunnan. Investigations were made every six months and lasted for 7 years. 661 FSWs found as HIV negative in the baseline study in March 2006 were chosen to study their LTF in the 7 year follow-up investigation. The Cox regression model was used to explore risk factors for HIV emerging infection and those for LTF. In June 2013, a survey was also conducted to explore the detailed reasons for loss to follow-up by contacting FSWs themselves. RESULTS: During 1 238.5 person-years of follow-up among 661 HIV negative FSWs, the HIV incidence rate was 1.29 (95% CI: 0.74-2.10)/100 person-year, and the LFT incidence rate was 48.68 (95% CI: 44.88-52.73) /100 person-year. The multivariate analysis showed drug abuse as an independent risk factor for FSWs' infection of HIV (adjusted risk ratio = 4.15, 95% CI: 1.43-12.02); FSWs over 25 years old (adjusted risk ratio = 0.68, 95% CI: 0.57-0.81), and drug abuse (adjusted risk ratio = 0.52, 95% CI: 0.35-0.79) were found with lower LFT rate to remain in the cohort. CONCLUSION: High LFT rate was found in FSW cohort study in Kaiyuan, Yunnan, while the HIV infection risk exposure of the LFT group was lower than the groups of HIV follow-up. HIV prevalence of FSWs in the city might be overestimated. Causes of LFT of FSWs group required further study in the future, and the cohort follow-up retention strategy for FSWs needs to be developed.

Drug use and sex work: competing risk factors for newly acquired HIV in Yunnan, China.

OBJECTIVE: To investigate the HIV incidence and its related factors among female sex workers (FSWs) in a high prevalence area where injection drug use is also widely documented. METHOD: A cross-sectional study of 1642 female sex workers (FSWs) was conducted in Honghe Prefecture of Yunnan Province. Interviewed-questionnaires were administrated to collect information on sexual partnerships, condom use and illicit drug using behaviors etc. Blood samples were collected to test for HIV antibodies, and all HIV seropositive specimens were tested with the BED IgG capture-based enzyme immunosorbent assay (BED-CEIA) to distinguish between new and established HIV infection (<153 days). RESULTS: 15.9% (261/1642) of participants reported ever having used drugs, and 7.4% had injected in recent 3 months. The overall HIV prevalence was 10.2% (168/1642), among which 16.7% (28/168) were identified as recent infections using BED-CEIA. The crude HIV incidence estimated from BED-CEIA results was 4.4 (95%CI 2.8-6.0) /100 person years (PY). Multivariate logistic analysis showed that an illicit drug using history (by either self-reporting or urine opiates testing) was both significant risk factors both for HIV established and recent infection (each p<0.05). Drug using FSWs (DU-FSW) reported more male clients in the previous week, and had significantly higher prevalence of HIV, chlamydia trachomatis and HSV-2 as compared to non DU-FSW (each p<0.05). CONCLUSION: Our results show that a history of drug use poses significant risks for both new and established HIV infection among FSWs, and that HIV-incidence among Honghe FSWs is relatively high compared to similar populations. Comprehensive interventions targeted at DU-FSWs' injection drug using and high risk sexual behaviors are urgently needed to reduce the rapid spread of HIV epidemic.

[Study on the feasibility and related factors on semen samples from condoms, collected from sexual partners of and by the female sex workers for HIV-antibody testing].

OBJECTIVE: To explore the feasibility and related factors of using semen samples from condoms collected by their female sex workers (FSWs) for HIV-antibody testing. METHODS: FSWs were recruited by outreach workers. Semen samples from condoms of their sexual partners (paid or regular) were collected by FSWs themselves after intercourse and for HIV testing. Male partners were asked to participate in the study. Questionnaires were administered for both FSWs and heir male sexual partners. Blood samples were also collected for HIV testing. RESULTS: In total, 54 FSWs with 43 of their regular sexual partners and 57 casual clients were recruited. HIV prevalence, determined from serum samples, were 33.33% among FSWs, 29.82% and 23.26% among their clients and regular sexual partners. 40.35% and 30.23% of the semen samples from the condoms they used, were tested positive for HIV among clients and regular sexual partners of the FSWs. The sensitivity of semen samples from condoms for HIV-antibodies was 100% among both clients and regular sexual partners of the FSWs, while the rates of specificity were 85.00% and 90.91% respectively. Data from Univariate analysis indicated that among FSWs, factors as the characteristics of self-reported needle sharing and the male sexual partners who had one child, were associated with the disparity between serum and condom semen sample for HIV-antibody testing. CONCLUSION: HIV prevalence in male clients and regular sexual partners of the FSWs might be overestimated according to the HIV-antibody testing results of semen samples from condoms collected by FSWs themselves. Lower specificity indicated that FSWs with positive HIV might have contaminated the semen samples from the condom used by their HIV negative sexual partners.

Microbicide acceptability and associated factors among female sex workers and male clients in Kaiyuan county, Yunnan province, China.

OBJECTIVES: To determine microbicide acceptability and associated factors among female sex workers (FSWs) and their clients in Yunnan, China. METHODS: Kaiyuan County, with high rates of HIV in FSWs, in Yunnan Province was chosen as the study site. Establishments were selected using stratified sampling, and FSWs were recruited using random sampling. Male clients of FSWs were also recruited. In-depth interviews and anonymous questionnaires were used to collect data. An acceptance rate was calculated for each individual variable, and factors associated with acceptability were assessed using multivariate analysis. RESULTS: Four hundred FSWs and 200 male clients were recruited. Microbicides were acceptable if they prevented HIV transmission effectively and safely, were lubricating, effective up to 24 hours, and <10 China Yuan (CNY) (US $1.50) per use. Eighty-one percent of participants indicated future intention to use microbicides. Factors associated with potential microbicide use included age, establishment stratum, price, perception of risk behavior, and knowledge of AIDS/sexually transmitted infections. CONCLUSIONS: The acceptablitiy of microbmicides is high among FSWs and their clients. Development of effective and affordable microbicides has great potential for controlling sexual transmission of the HIV epidemic in China.

HIV prevalence and risk behaviors among male clients of female sex workers in Yunnan, China.

OBJECTIVES: To assess the prevalence and risk factors of HIV among male clients of female sex workers (FSWs) in China. METHODS: Convenience sampling methods were used to recruit 315 clients using FSW-client and client-client networks. Subjects provided information on sociodemographic characteristics and sexual and drug behavior patterns. Blood samples were collected for HIV testing and urine samples for opiate testing. RESULTS: Overall HIV prevalence was 6.0%; among drug users, it was 30.8%. 33.7% of respondents reported that they always use condoms in commercial sex and 63.5% that they used a condom in the last commercial sex episode. Drug use (OR: 6.1; 95% CI: 1.7 to 21.4) and lack of a regular sexual partner (OR: 6.3; 95% CI: 1.8 to 21.9) were significantly associated with HIV infection. CONCLUSIONS: Clients of FSWs serve as potential bridges for HIV transmission from the high-risk FSWs to the low-risk general population, making them a key target for intervention. High HIV prevalence rates among clients in Kaiyuan is particularly alarming given their risk behavior patterns including high rates of partner exchange, low condom use rates, and drug-using behaviors. Innovative interventions are needed to reduce the risk of HIV among clients and reduce the bridge of transmission to the general population.

Association between testing for human immunodeficiency virus and changes in risk behaviors among injecting drug users in southern China.

BACKGROUND: There is growing need for research in China regarding posttest risk behavior differences among injecting drug users that explores the effect of various testing modes (nonvoluntary vs. voluntary) and other related factors on changes in posttest risk behaviors. METHODS: One hundred seventy-two study subjects self-reported human immunodeficiency virus (HIV)-related personal risk behaviors including condom use rates and needle-sharing habits. Fisher exact test and multivariate regression analysis compared the impact of HIV testing mode on ongoing risk behaviors for HIV transmission. RESULTS: The study found that those who received positive test results were 5.37 times more likely to increase condom use with regular sexual partners, that men were 8.8 times more likely than women to increase posttest condom use in commercial sexual activities. Needle-sharing behavior was significantly lower for subjects who tested HIV-positive (odds ratio [OR]: 4.5), who notified sexual partners of test results (OR: 0.03), and who had tested voluntarily (OR: 0.04). CONCLUSION: Based on the study results this report concludes that voluntary HIV testing and encouragement of partner notification of test results should be incorporated into China's national testing strategy.

[Study on the association between vaginal douching and sexually transmitted diseases among female sex workers in a county of Yunnan province].

OBJECTIVE: To explore the epidemic characteristics of vaginal douching, human immunodeficiency virus (HIV) and other sexually transmitted diseases(STD) among female sex workers (FSWs) in Yunnan province. METHODS: FSWs were recruited to be investigated on their demographic data, drug abuse and sexual behavior, HIV/AIDS knowledge and procreation health status. Venous blood were collected to test for HIV, herpes simplex virus 2 (HSV-2) and syphilis while urine specimen was for morphine, cervical secretion for Gonorrhoea and Chlamydia trachomatis, and vaginal secretion for Trichomonas. RESULTS: A total number of 833 blood specimen were collected, in which 84 specimen were confirmed to be HIV positive with a prevalence rate of 10.1%. The prevalence rates of syphilis and HSV-2 were 8.2% and 68.4% respectively. 832 vaginal and cervical secretion specimen were collected with the prevalence rates of Gonorrhoea, Chlamydia trachomatis and Trichomonas were 11.5%, 28.2% and 11.9% respectively. In multivariate logistic analysis, the factors associated with vaginal douching were: being Han nationality, locations of sex work at middle/high level, ever heard of HIV/AIDS, emerged hypogastric pain last year, the number of sex work location > or =4. CONCLUSION: Vaginal douching was shown a risk factor for HIV and some STD.