High-risk behaviour and HIV infection risk among non-local men who have sex with men with less than a single year's residence in urban centres: a multicentre cross-sectional study from China.

OBJECTIVES: Traditionally, subjects' migration status has usually been defined on the basis of their registered residency status. We attempted to redefine migration based on the duration of residency in their cities of migration and to explore more precisely the impact of migration on HIV infection risk in men who have sex with men (MSM). METHODS: A multisite cross-sectional study was conducted during 2012-2013 in seven Chinese cities. Questionnaire surveys were conducted and blood was drawn to test for antibodies to HIV, syphilis and herpes simplex virus-2 (HSV-2). MSM who were unregistered local residents and had resided in their cities of migration for ≤1 or >1 year were defined as migrant MSM, or transitional MSM, respectively. RESULTS: Compared with transitional MSM and local MSM, migrant MSM had poorer HIV knowledge and higher rates of high-risk behaviour, including earlier sexual debut, multiple sexual partners, participation in commercial sex and recreational drug use. Multivariate logistic regression analysis showed that HIV prevalence among migrant MSM was higher than local MSM (p<0.05). This relationship, however, did not hold for transitional MSM and local MSM (p>0.05). Male sex work, recreational drug use, syphilis infection and HSV-2 infection were independently associated with HIV infection among migrant MSM. CONCLUSIONS: Non-local MSM with shorter residence were at greater risk of HIV acquisition. More focus should be placed on HIV behavioural interventions targeting non-local MSM with temporary residence.

Commercial sex and risk of HIV, syphilis, and herpes simplex virus-2 among men who have sex with men in six Chinese cities.

BACKGROUND: Men who have sex with men (MSM) are at high risk of HIV and sexually transmitted infections (STIs) in China and globally. Engaging in commercial sex put them at even greater risk. This study estimated the prevalence of HIV/STIs among three subgroups of MSM: MSM who sold sex (MSM-selling), MSM who bought sex (MSM-buying), and non-commercial MSM (NC-MSM) and evaluated the relationship between commercial sex and HIV/STIs. METHODS: We conducted a cross-sectional survey among MSM in six Chinese cities (Shenyang, Ji'nan, Changsha, Zhengzhou, Nanjing, and Kunming) from 2012 to 2013. Data on socio-demographics and sexual behaviors were collected. Serological tests were conducted to detect HIV, syphilis, and human simplex virus type 2 (HSV-2). RESULTS: Of 3717 MSM, 6.8% were engaged in commercial sex. The overall prevalence of HIV, syphilis and HSV-2 infections was 11.1, 8.8 and 12.1%, respectively. MSM-selling had higher prevalence of HIV (13.4%), syphilis (12.1%) and HSV-2 (17.9%) than NC-MSM (10.9, 8.7 and 11.9% for HIV, syphilis and HSV-2, respectively), though the differences are not statistically significant. Among MSM-selling, HIV prevalence was significantly higher for those who found sex partners via Internet than those did not (19.4% vs. 8.1%, P = 0.04). Compared to NC-MSM, MSM-selling were more likely to use recreation drugs (59.3% vs. 26.3%), have unprotected anal intercourse (77.9% vs. 61.7%), and have ≥10 male sex partners (46.2% vs. 6.2%) in the past 6 months (each P < 0.05). CONCLUSIONS: All three subgroups of MSM in six large Chinese cities have high prevalence of HIV/STIs. Those who sell sex only have a particularly high risk of acquiring and transmitting disease, and therefore, they should be considered as a priority group in HIV/STIs surveillance and intervention programs.

Recreational drug use and risks of HIV and sexually transmitted infections among Chinese men who have sex with men: Mediation through multiple sexual partnerships.

BACKGROUND: Recreational drug use (RDU) may result in sexual disinhibition and higher risk for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in China. We assessed whether RDU was associated with HIV, syphilis, and herpes simplex virus type 2 (HSV-2) within the context of multiple sexual partnerships and unprotected sex. METHODS: We conducted a cross-sectional study among sexually-active MSM in six Chinese cities (Kunming, Jinan, Changsha, Zhengzhou, Nanjing, and Shanghai) in 2012-2013. We interviewed participants regarding RDU and sexual activity and drew blood for HIV, syphilis, and HSV-2. We fit multiple logistic regression models to assess associations of drug use and HIV, syphilis and HSV-2 infections, controlling for number of sexual partners and unprotected sex. RESULTS: Of 3830 participants, 28% reported ever using ≥1 of these drugs in the past 6 months: popper (alkyl nitrites), ecstasy, ice (methamphetamine), amphetamine, tramadol, and ketamine. In the past six months, 62% of MSM reported ≥2 sexual partners and 76% did not use condoms at last sexual encounter. HIV, syphilis and HSV-2 prevalences were 9.2%, 12.2%, and 10.3%, respectively.RDU was associated with HIV infection (aOR = 1.67; 95% CI, 1.31-2.13). Men with RDU were more likely to report multiple sexual partners (OR = 1.69; 95% CI, 1.44-1.98) and unprotected sex (aOR = 1.25; 95% CI, 1.05-1.49). The RDU-HIV association persisted (aOR = 1.58; 95% CI = 1.23-2.02) after adjusting for numbers of partners. CONCLUSIONS: RDU was associated with multiple sexual partnerships, unprotected sex, and HIV among Chinese MSM. It is plausible that RDU is a driver of increased sexual/HIV risk and/or may be an associated behavior with sexually risky lifestyles. Community engagement is needed.

Identity, stigma, and HIV risk among transgender women: a qualitative study in Jiangsu Province, China.

BACKGROUND: Transgender women have multiple disparities globally, including social rejection and stigma, HIV infection and untreated mental health problems. However, few data on transgender women are available in China. Therefore, this study aimed to explore transgender women's experiences on gender identity, disclosure, discrimination, transgender-specific medical care, and perceptions of HIV and sexually transmitted infections (STI) risk in China. METHODS: A qualitative study was conducted in Nanjing and Suzhou city, China in 2018. Key informant interviews (n = 14) and focus group discussions (n = 2) with diverse transgender women were implemented. Text was transcribed and translated, and Dedoose™ software was used for coding, analysis and interpretation by the research team. RESULTS: Chinese transgender women share experiences with transgender women worldwide, including a long and challenging identity search, stigma and discrimination, poor access to trans-specific services and unmet needs for mental health care. Features unique to them include terms used for self-identification, culturally-shaped expectations for reproduction, and ideals of placing the familial and societal welfare over personal fulfillment. Social networks of this population appear sparse, scattered, and underground. Familial rejection was experienced by nearly all respondents. Perceptions of HIV and STI risk and history of HIV testing were notably low. CONCLUSIONS: Transgender women in China face high social rejection and discrimination along with unmet need for various types of healthcare. Scaling up transgender-specific services including gender-affirming medical care, mental health care and HIV/STI prevention are warranted to address the social, medical and mental health of transgender women in China.

Multifunctional Supramolecular Materials Constructed from Polypyrrole@UiO-66 Nanohybrids and Pillararene Nanovalves for Targeted Chemophotothermal Therapy.

Multifunctional supramolecular nanomaterials capable of targeted and multimodal therapy hold great potential to improve the efficiency of cancer therapeutics. Herein, we report a proof-of-concept nanoplatform for effective chemophotothermal therapy via the integration of folic acid-based active targeting and supramolecular nanovalves-based passive targeting. Inspired by facile surface engineering and designable layer-by-layer assembly concept, we design and synthesize PPy@UiO-66@WP6@PEI-Fa nanoparticles (PUWPFa NPs) to achieve efficient synergistic chemophotothermal therapy, taking advantage of the desirable photothermal conversion capability of polypyrrole nanoparticles (PPy NPs) and high drug-loading capacity of hybrid scaffolds. Significantly, pillararene-based pseudorotaxanes as pH/temperature dual-responsive nanovalves allow targeted drug delivery in pathological environment with sustained release over 4 days, which is complementary to photothermal therapy, and folic acid-conjugated polyethyleneimine (PEI-Fa) at the outmost layer through electrostatic interactions is able to enhance tumor-targeting and therapeutic efficiency. Such PUWPFa NPs showed efficient synergistic chemophotothermal therapy of cervical cancer both in vitro and in vivo. The present strategy offers not only the distinctly targeted drug delivery and release, but also excellent tumor inhibition efficacy of simultaneous chemophotothermal therapy, opening a new avenue for effective cancer treatment.

Protective effect of resveratrol against nigrostriatal pathway injury in striatum via JNK pathway.

Nigrostriatal pathway injury is one of the traumatic brain injury models that usually lead to neurological dysfunction or neuron necrosis. Resveratrol-induced benefits have recently been demonstrated in several models of neuronal degeneration diseases. However, the protective properties of resveratrol against neurodegeneration have not been explored definitely. Thus, we employ the nigrostriatal pathway injury model to mimic the insults on the brain. Resveratrol decreased the p-ERK expression and increased the p-JNK expression compared to the DMSO group, but not alter the p38 MAPK proteins around the lesion site by Western blot. Prior to the injury, mice were infused with resveratrol intracerebroventricularly with or without JNK-IN-8, a specific c-JNK pathway inhibitor for JNK1, JNK2 and JNK4. The study assessed modified improved neurological function score (mNSS) and beam/walking test, the level of inflammatory cytokines IL-1ß, IL-6 and TNF-α, and striatal expression of Bax and Bcl-2 proteins associated with neuronal apoptosis. The results revealed that resveratrol exerted a neuroprotective effect as shown by the improved mNSS and beam latency, anti-inflammatory effects as indicated by the decreased level of IL-1ß, TNF-α and IL-6. Furthermore, resveratrol up-regulated the protein expression of p-JNK and Bcl-2, down-regulated the expression of Bax and the number of Fluoro-Jade C (FJC) positive neurons. However, these advantages of resveratrol were abolished by JNK-IN-8 treatment. Overall, we demonstrated that resveratrol treatment attenuates the nigrostriatal pathway injury-induced neuronal apoptosis and inflammation via activation of c-JNK signaling.

The current status of syphilis prevention and control in Jiangsu province, China: A cross-sectional study.

OBJECTIVE: To analyze the midterm evaluation data from the National Syphilis Prevention and Control Plan (2010-2020) and evaluate the current status of syphilis prevention and control in Jiangsu province, China. METHODS: We collected data via (1) field surveys conducted in 2015 and (2) data recorded in existing syphilis surveillance systems. We conducted descriptive statistical analysis to evaluate the current landscape of syphilis control initiatives and their potential effect in syphilis control. RESULTS: The incidence of all cases of syphilis decreased from 2010 (32.3 per 100,000) to 2015 (30.1 per 100,000), with an annual growth of -1.17% (x2trend = -7.52, P<0.001) in Jiangsu province. The incidence of primary and secondary syphilis and congenital syphilis both decreased significantly from 2010 to 2015. The average awareness rate of syphilis knowledge among professional personnel was 95.4% (3781/3963). Rural residents had the lowest awareness rate (83.5%, 1875/2245) and commercial sex workers had the highest awareness rate (92.1%, 7804/8474) in 2015. Only 47.8% (33908/70894) of patients received provider-initiated syphilis counseling and testing (PISTC) services in sexually transmitted disease (STD) clinics, but 94.5% (87927/93020) of all syphilis patients received free testing for syphilis. Overall, 97.2% (9378/9648) of syphilis reported cases of syphilis at medical institutions were confirmed to be accurate, and 92.2% (5850/6345) of patients diagnosed with syphilis at medical institutions received treatment with penicillin. CONCLUSION: The syphilis incidence rate in Jiangsu has decreased in recent years, but remains at a high level. It is essential to promote PISTC services to improve knowledge of syphilis and rates of testing and treatment in Jiangsu province.

Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China: a multicentre cross-sectional survey.

BACKGROUND: Delayed or inappropriate treatment for sexually transmitted diseases (STDs) increases the risk of HIV acquisition and may cause other harmful outcomes. However, studies on STD treatment-seeking behaviour and correlated factors in men who have sex with men (MSM) are scarce. This information is crucial for the promotion of STD treatment-seeking behaviour and reduction of HIV transmission among Chinese MSM. METHODS: During 2012-2013, a multicentre cross-sectional study was conducted in 7 Chinese cities. Participants completed an interview-questionnaire and gave venous blood samples, which were then tested for antibodies to HIV, syphilis, and herpes simplex virus-2 (HSV-2). MSM who tested positive for syphilis/HSV-2 or had obvious STD-related symptoms within the last 12 months were defined as suspected STD-infected MSM. RESULTS: Of the 4 496 eligible MSM who completed this survey, 24.4% (1 096/4 496) were categorized as suspected STD-infected MSM. 35.7% (391/1 096) of these MSM with suspected STD infections sought STD treatment in clinics within the last 12 months. Among MSM who did not attend STD clinics for treatment, the prevalence of syphilis and HSV-2 was significantly higher; the HIV prevalence and incidence within this subpopulation reached as high as 14.5% and 12.2/100 person-years, respectively. Multivariate logistic regression analysis indicated that having 7-12 years of education (vs. ≤6 years; aOR, 2.5; 95%CI, 1.0-6.1), ≥13 years of education (vs. ≤6 years: aOR, 2.8; 95%CI, 1.2-7.0), monthly income >500 USD (vs. ≤500 USD: aOR, 1.5; 95%CI, 1.1-2.1), obvious STD-related symptoms within last 12 months (aOR, 5.3; 95%CI, 3.7-7.5), being HIV infected (aOR, 1.7; 95%CI, 1.1-2.6), currently syphilis infected (aOR, 0.6; 95%CI, 0.4-0.9) and HSV-2 infected (aOR, 0.6; 95%CI, 0.5-0.9) were independent correlates with seeking STD treatment in clinics among Chinese MSM. CONCLUSIONS: The high prevalence of STD infection coupled with a low proportion of individuals who exhibit appropriate treatment-seeking behaviour create a high risk of a growing HIV epidemic among Chinese MSM. Models that prioritize better screening for and education about STDs should be urgently implemented, especially among low-income MSM.

Regulation and role of ERK phosphorylation in glial cells following a nigrostriatal pathway injury.

This study was undertaken to examine the function of extracellular signal-regulated kinase (ERK) signaling pathway on the proliferation and activation of microglia/macrophage and astrocytes after brain injury in mice. The result of Western blot showed that p-ERK was immediately activated after injury (<4h), but the duration was short (<4 days). According to immunofluorescence double staining, it was found that at 4 and 8h after injury, p-ERK was expressed in microglia/macrophages, and that more cells were co-expressed by p-ERK and IBA-1 (microglia/macrophage marker) at 8h; at days 1 and 4, p-ERK was expressed in astrocytes, and more cells were co-expressed by p-ERK and GFAP (astrocyte marker) at day 4. After injury, the mice were injected with U0126 (MAPK/ERK signaling pathway inhibitor) via the femoral vein. Compared with those injected with DMSO, the cell number co-expressed by p-ERK and IBA-1 or GFAP significantly decreased (P<0.05). The increase of microglia/macrophage and astrocyte caused by injury was remitted, and the positive cell number significantly decreased (P<0.05). Western blot showed that the expression quantity of IBA-1 and GFAP significantly decreased (P<0.05). Furthermore, the ERK signaling pathway was involved in the proliferation and activation of the two glial cells types and improved long-term neurobehavioral function after brain injury. Therefore, the exploration of the formation mechanism of glial scar after injury and further research on the therapeutic method of neural regeneration are essential.

Acute gastroenteritis outbreak caused by a GII.6 norovirus.

AIM: To report an acute gastroenteritis outbreak caused by a genogroup 2 genotype 6 (GII.6) strain norovirus in Shanghai, China. METHODS: Noroviruses are responsible for approximately half of all reported gastroenteritis outbreaks in many countries. Genogroup 2 genotype 4 strains are the most prevalent. Rare outbreaks caused by GII.6 strains have been reported. An acute gastroenteritis outbreak occurred in an elementary school in Shanghai in December of 2013. Field and molecular epidemiologic investigations were conducted. RESULTS: The outbreak was limited to one class in an elementary school located in southwest Shanghai. The age of the students ranged from 9 to 10 years. The first case emerged on December 10, 2013, and the last case emerged on December 14, 2013. The cases peaked on December 11, 2013, with 21 new cases. Of 45 students in the class, 32 were affected. The main symptom was gastroenteritis, and 15.6% (5/32) of the cases exhibited a fever. A field epidemiologic investigation showed the pathogen may have been transmitted to the elementary school from employees in a delicatessen via the first case student, who had eaten food from the delicatessen one day before the gastroenteritis episodes began. A molecular epidemiologic investigation identified the cause of the gastroenteritis as norovirus strain GII.6; the viral sequence of the student cases showed 100% homology with that of the shop employees. Genetic relatedness analyses showed that the new viral strain is closely related to previously reported GII.6 sequences, especially to a strain reported in Japan. CONCLUSION: This is the first report to show that norovirus strain GII.6 can cause a gastroenteritis outbreak. Thus, the prevalence of GII.6 noroviruses requires attention.

Association of early age at establishment of chronic hepatitis B infection with persistent viral replication, liver cirrhosis and hepatocellular carcinoma: a systematic review.

Age at infection with hepatitis B virus (HBV) is a known risk factor for chronic HBV infection. However, in addition, there is some evidence that early age at infection further increases the risk of primary liver cancer beyond its association with increased risk of chronic infection. This systematic review of observational studies assesses the association between age at initiation of chronic HBV infection and liver cirrhosis, hepatocellular carcinoma, and their predictors including indicators of ongoing viral replication and hepatic damage. The review includes birth order and maternal HBV serology as proxies for age at infection. Electronic searches in two English-language (Medline and Embase, until Jan 2012) and two Chinese-language (CNKI and SinoMed, until Sep 2012) databases without language restriction and manual search through reference lists identified 7,077 papers, of which 19 studies of 21 outcomes (8 primary liver cancer, 1 liver cirrhosis, 10 viral replication and 2 liver inflammation) are included. One study directly examined the age at infection in a longitudinal cohort, 12 assessed maternal sero-status and 6 investigated birth order. The direction of associations in all studies was in accordance with our hypothesis that earlier age at infection is associated with worse outcomes in addition to its effect of increasing the probability of chronic HBV infection. This has implications for the control of hepatitis B.

[Factors associated with HIV infection among men who have sex with men in Nanjing, Suzhou and Yangzhou: a 1:4 matched case-control study].

OBJECTIVE: This study assessed the main factors associated with HIV infection among men having sex with men (MSM), in order to provide evidence for future intervention. METHODS: A case-control study was conducted among HIV cases identified at the MSM survey in Nanjing, Suzhou and Yangzhou cities from May to July in 2008. Each HIV case was matched by 4 HIV negative MSM who participated consecutively right after the HIV case was identified at the same survey, same time and in the same city. A national core MSM survey questionnaire was used with addition of variables of local interest. Fitting conditional logistic regression model was applied for univariate and multivariate analysis. RESULTS: During the survey, 62 HIV positive cases were identified and 248 controls were matched. Data from univariate analysis showed that, inconsistent condom use, syphilis infection, self reported sexually transmitted infection (STI) symptoms and/or signs, unprotected anal sex (UAI) were risk factors, with OR values of 5.56 (95% CI: 1.82-16.96), 2.19 (95% CI: 1.18-4.05), 2.50 (95% CI: 1.13-5.50) and 3.13 (95% CI: 1.64-5.98) respectively. Online cruising and receptive anal sex were protective factors with OR values as 0.47(95% CI: 0.22-0.998) and 0.67 (95% CI: 0.23-1.97). Through multivariate analysis, it was found that syphilis, age of having experienced first insertive sexual intercourse and UAI were risk factors to HIV transmission, with OR values of 2.28 (95% CI: 1.05-4.94), 4.16 (95% CI: 1.63-10.66) and 1.11 (95% CI: 1.04-1.18) respectively. Compared with non-anal sex, bisexual (OR = 0.41, 95% CI: 0.18-0.97) behavior seemed a protected factor. CONCLUSION: Syphilis infection, UAI and self reported STI symptoms and/or signs were risk factors related to HIV transmission while bisexual seemed a protective factor.