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Background: Sexual function is an important yet understudied aspect of overall health and well‐being in older adults. We aimed to examine sexual function and its correlates among people 50 years and older in China. Methods: We enrolled people aged 50 years and older recruited from four regions in China between September 2021 and July 2022 in a multicenter cross‐sectional study. Data were collected through an investigator‐administered questionnaire about demographic characteristics, health characteristics, and sexual function status. Logistic regression was used to assess correlates of lower sexual function (the highest quintile of the sex‐specific population distribution of Natsal‐SF scores [i.e., lower functioning compared with the remaining]). Results: A total of 465 women and 832 men who were sexually active in the past year were included in the analysis (mean age: 60.4 ± 7.2) [Correction added after first online publication on 12 Feb 2024. The word "years" has been changed to "year" in this sentence.]. Over a quarter of all participants were dissatisfied with their sex life. Notably, 92 women and 167 men were categorized as having a lower sexual function. Age (in men only), living in urban areas, general health status, being underweight or overweight (in men only), and having depressive symptoms were associated with lower sexual function. Among all participants, 43.1% of men and 54.0% of women experienced sexual response problems lasting 3 months or more. Less than one‐third of all participants had sought help or advice for sex life in the past year. Conclusions: Sexual dysfunction and sexual dissatisfaction are prevalent among older adults in China and are associated with self‐assessed poor health. More efforts are needed to better understand sexual health needs and tailor service provision. [ABSTRACT FROM AUTHOR]

The association between HIV pre‐exposure prophylaxis (PrEP) and the natural history of human papillomavirus (HPV) has not been well documented. Our objective was to evaluate the impact of PrEP on the prevalence, incidence, and clearance of anal HPV among men who have sex with men (MSM). Sexually active, HIV‐negative MSM aged 18 years and older in Xinjiang, China since September 1, 2016, were enrolled in an ongoing observational cohort study of HPV. At baseline and every 6 months, an anal swab was taken to test for HPV and a questionnaire on sociodemographic characteristics and sexual behaviors was collected. Those who consented to receive PrEP were enrolled in an open‐label PrEP intervention study from November 1, 2019, to June 30, 2021. This study analyzed data from participants present in the HPV cohort between November 1, 2019, and June 30, 2021. We compared the prevalence, incidence, and clearance of anal HPV between men who received PrEP (PrEP users) and those who did not (non‐PrEP users), and compared men before and after initiating PrEP. We calculated prevalence ratios (PRs), incidence rate ratios (IRRs), and clearance rate ratios (CRRs) for both comparisons. Of the 870 participants present in the HPV cohort during the period between November 1, 2019, and June 30, 2021, 859 had adequate β‐globin for HPV genotype testing and were included in our study. Among them, 429 were PrEP users, while 430 were non‐PrEP users. Median age was 32 years (interquartile range [IQR]: 26–38). Among PrEP users, 217 were tested for anal HPV before PrEP initiation. PrEP users had lower prevalence of HPV 45, 51, and 54 (PRs: 0.27 [95% CI: 0.09–0.80], 0.42 [0.21–0.85], and 0.41 [0.17–0.99], respectively) and lower clearance of HPV 16 (CRR: 0.31 [0.10–0.91]) compared with non‐PrEP users. PrEP users exhibited lower prevalence of HPV 51 (PR: 0.31 [0.12–0.84]), lower incidence of HPV 6, 11, 16, 39 and 61 (IRRs: 0.34 [0.13–0.90], 0.26 [0.08–0.87], 0.44 [0.21–0.91], 0.21 [0.05–0.93], and 0.19 [0.04–0.82], respectively), as well as higher clearance of HPV 52 (CRR: 2.17 [1.08–4.35]) after PrEP initiation. PrEP use may lower the risk of HPV infection among MSM in Xinjiang, China. Our findings further extend the knowledge of the impact of PrEP on sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Background: Factory workers are a key population for HIV transmission in China, as they often engage in sexual risk behaviours. This study aims to evaluate sexual risk behaviours and associated factors among factory workers in Shenzhen, China. Methods: A cross-sectional study was conducted by using multi-stage stratified cluster random sampling. Full-time workers aged ≥18 years were eligible to participate in the study. A self-administered questionnaire was used to collect information. Univariate and multivariable logistic regression were applied to assess factors associated with sexual risk behaviours. Results: A total of 2029 factory workers were included. Mean age was 37.2 (±4.4) years; 48.5% were men. Two-thirds (64.9%) had had vaginal intercourse. Their sexual risk behaviours included condomless sex with casual partners in the last sex episode (23.6%), multiple sex partners (11.5%) and engaging in commercial sex (8.4%), in the past year. Having HIV/AIDS knowledge (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.24–0.70) and using a condom at sexual debut (AOR 0.08, 95% CI 0.05–0.13) were factors associated with condomless sex with casual partners in the last sex episode. Males (AOR 3.03, 95% CI 1.96–4.69 and AOR 2.19, 95% CI 1.33–3.60), local workers (AOR 2.11, 95% CI 1.01–4.42 and AOR 3.42, 95% CI 1.63–7.21), being single (AOR 2.04, 95% CI 1.39–3.01 and AOR 2.49, 95% CI 1.61–3.87), having sexual debut aged <18 years (AOR 5.98, 95% CI 3.28–10.89 and AOR 3.34, 95% CI 1.74–6.39), and substance use (AOR 2.01, 95% CI 1.38–2.93 and AOR 4.43, 95% CI 2.85–6.87) were associated with both having multiple sex partners and engaging in commercial sex in the past year. Conclusions: Sexual risk behaviours were prevalent despite most participants having basic HIV/AIDS knowledge. Future workplace-based prevention programs should target factory workers and there should be a focus on enhanced sexual education to reduce HIV transmission in China. Sexual transmission has been the main mode of HIV transmission, and data on sexual risk behaviours among factory workers from various industries are scarce in China. Sexual risk behaviours that showed associations with certain characteristics and experience of sexual debut were prevalent among factory workers in Shenzhen, China. There are massive labour forces in China, indicating an urgent need to strengthen sexual health education and promote safer sexual behaviours among factory workers. [ABSTRACT FROM AUTHOR]

The Information-Motivation-Behavioral skills (IMB) model of antiretroviral therapy (ART) adherence was applied in people living with HIV/AIDS in Shanghai, China to understand how adherence-related information, motivation and behavioral skills would affect ART adherence. The LifeWindows Information-Motivation-Behavioral Skills ART Adherence Questionnaire (LW-IMB-AAQ) was translated into Chinese and used. The IMB model was then implemented by testing standardized path estimates with standard model fitness indices in the participants. 426 participants from 11 community centres in Putuo district of Shanghai were recruited, of which 95.3% reported a high level of adherence (>95% adherence). The fitness indices of the final adjusted model were χ2 = 6.110, df = 7, p = 0.527(>0.05), CFI = 1.000(>0.9) and RMSEA = 0.000 (<0.08). In the model, information, which was separated into two sections (the perceived effect of ART on health and knowledge about ART medication), had an indirect effect on the ART adherence through behavioral skills, while motivation did not have such an effect. Neither information nor motivation had a direct effect on ART adherence. In addition, motivation was related to the two sections of information. The feasibility of the IMB model of ART adherence is verified by its application to predictive of adherence-related behaviors among HIV+ patients in this study. [ABSTRACT FROM AUTHOR]

Obtaining antiretroviral therapy (ART) was a challenge for people living with HIV (PLHIV) in China during the COVID-19 outbreak. On 26 January 2020, the Chinese Center for AIDS/STD Control and Prevention issued a nationwide directive to relax restrictions on where and when PLHIV could refill ART. This qualitative study explored unexpected barriers under this directive and recommendations to improve future ART delivery. Between February 11 and February 15 2020, in-depth interviews of 4 groups of stake holders related to ART refilling (i.e., PLHIV, community-based organization employees, CDC staff, infectious disease physicians and nurses), were conducted via WeChat. Data were managed by NVivo 11.0 and transcripts were coded using thematic analysis. Sixty-two interviews were conducted. The main barriers to refilling ART included: (1) inconsistent documentation requirements to refill ART, (2) lack of specific protocols on ART refilling, (3) insufficient staffing, and (4) regimen verification and drug shortages. The most common recommendations to improve future ART delivery were: (1) to establish a nationwide system to distribute ART and (2) increase the number of pills delivered with each ART refill. Strengthening protocols and systems to refill ART and improving collaboration is key to preventing interruptions in ART among PLHIV during public health emergencies. [ABSTRACT FROM AUTHOR]

The World Health Organization declared monkeypox as a Public Health Emergency of International Concern. A cross-sectional online survey was conducted to understand beliefs, attitudes, perceived preventive measures, and vaccination acceptance related to monkeypox in the public in China. Between August 30 and September 15, 2022, we recruited adults through an online survey platform. Demographic characteristics, perceptions, common knowledge, concerns, attitudes, willingness to adopt preventive measures (including hygiene practices, social distancing, and travel avoidance), and vaccination acceptance related to monkeypox were collected. Logistic regression was used to assess correlates of concerns about monkeypox, willingness to adopt preventive measures, and vaccination acceptance. 2135 participants were recruited (median age: 31.4 years). 62.7% were concerned about monkeypox. 33.2% were more concerned about monkeypox compared to COVID-19. Males (aOR 0.61, 95%CI 0.50–0.74), accessing monkeypox information from the Internet (0.77, 0.61–0.98), and willingness to adopt monkeypox vaccine (2.9, 2.38–3.53) were associated with concerns about monkeypox. Most participants were willing to adopt precautions (76.3% hygiene practices, 68.2% social distancing, 85.9% travel avoidance). Individuals who were concerned about monkeypox (hygiene practices: 2.09, 1.69–2.59; social distancing: 1.78, 1.46–2.16; travel avoidance: 1.74, 1.34–2.26) and had better knowledge about monkeypox (hygiene practices: 1.85, 1.48–2.31; social distancing: 2.17, 1.77–2.66; travel avoidance: 1.74, 1.34–2.26) were more likely to adopt precautions. 68.8% were willing to adopt monkeypox vaccine. Participants with older age (aged 40–49: 0.57, 0.38–0.85; aged 50 +: 0.50, 0.31–0.81), and higher income (¥6000–10,000: 0.61, 0.39–0.95; ≥¥10,000: 0.48, 0.30–0.77) were less likely to adopt the monkeypox vaccine. Being concerned more about monkeypox compared to COVID-19 (1.63, 1.31–2.02), and having better knowledge about monkeypox (1.34, 1.09–1.66) were associated with willingness to adopt vaccination. Compared with COVID-19, monkeypox attracted significantly less attention in the public in China, who currently have insufficient monkeypox knowledge. Interventions aimed at improving monkeypox knowledge and precautions among different groups of individuals in China are needed. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Re-emerging human mpox (previously known as monkeypox) is spreading around the world. According to existing studies, the current mpox pandemic mainly affects men who have sex with men (MSM), including male sex workers (MSW). Our study aimed to assess mpox knowledge and attitude towards mpox vaccination among MSW in China. Methods: A web-based, cross-sectional survey was conducted in August 2022. We collected participants' socio-demographic characteristics and knowledge with 15 knowledge items related to mpox. Modified Bloom's cut-off points of 80% (total score > 12) was used to indicate good knowledge. Multivariable regression analysis was used to assess factors of mpox knowledge and attitude towards mpox vaccination. Results: A total of 154 MSW were recruited (age: median = 22, interquartile range, IQR = 12). Of the 154 MSW, 49.4% had good knowledge of mpox, and 63.0% were willing to be vaccinated against mpox. We found that good knowledge was associated with being single [adjusted odds ratio (AOR) = 2.46, 95% confident interval (CI) (1.22–4.87)], being unemployed [5.01, 1.21–20.70] and willingness to be vaccinated [2.51, 1.14–5.54]. Willingness to get vaccinated was related to age [1.06, 1.00–1.12], chronic diseases history [8.53, 1.01–71.68], and agreement with "priority for high-risk groups if mpox vaccine is in short supply" [2.57, 1.01–6.54]. Conclusions: We found that MSW had suboptimal mpox knowledge and a high willingness to be vaccinated against mpox. MSW who are single and willing to be vaccinated may have good knowledge of mpox. These findings underscore the necessity of providing health education on mpox among MSW. When the mpox vaccine is in short supply, priority should be given to high-risk groups, such as MSW. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) have been recommended for targeted monkeypox vaccination. We aimed to investigate monkeypox awareness and explore the correlates of monkeypox vaccination hesitancy among MSM in China. We conducted a cross‐sectional survey from August 10 to September 9, 2022. Awareness related to monkeypox and attitude toward monkeypox vaccination among MSM aged ≥18 years were collected. Multivariable logistic regression was applied to evaluate correlates of vaccination hesitancy. The discrepancy in awareness between subgroups regarding HIV status was assessed. A total of 1090 MSM were included (age: median 30 years, interquartile range [IQR], 25–35; HIV‐infected: 53.12%). Only 13.85% of respondents expressed high monkeypox vaccination hesitancy. Hesitancy was associated with no fixed income (adjuster odds ratio [aOR], 2.46, 95% confidence interval [CI], 1.48–4.11), infrequent information following (sometimes, 3.01, 1.55–5.83; seldom or never, 5.66, 2.58–12.45), and lack of worries about monkeypox endemic (1.78, 1.11–2.87). Participants who believed that HIV‐infected cases accounted for a smaller proportion (1.62, 1.01–2.60), disagreed that monkeypox virus could be detected in semen (2.21, 1.26–3.88), and considered either replication‐competent (1.84, 1.14–2.96) or replication‐deficient (4.80, 2.26–10.21) monkeypox vaccine unsuitable for HIV‐infected people were generally more hesitant. Compared with HIV‐uninfected MSM, HIV‐infected MSM supported more for vaccination promotion. MSM in China had low hesitancy toward monkeypox vaccination. Safety and affordability of vaccine and availability of information were essential aspects to reduce hesitancy. Education on vaccination benefits should be encouraged to promote future vaccination plans. [ABSTRACT FROM AUTHOR]

Background: Disclosure of sexual orientation to others (outness) might be associated with sexual and mental health among gay and bisexual men (GBM) attending university. We aimed to characterise outness and investigate factors correlated with outness among GBM attending university in China.Methods: Between September 2018 and March 2019, GBM attending university were recruited in six cities in China. Information on sociodemographic characteristics, outness and sexual behaviours were collected using a self-administered questionnaire. Each participant was tested for HIV/STIs. Correlates of outness were assessed using multivariable logistic regression.Results: A total of 400 GBM attending university were recruited, of whom 251 (62.8%) had disclosed their sexual orientation. Men who served as student leaders (adjusted odds ratio [AOR]=2.28, 95% CI: 1.46-3.54) and donated blood (AOR 1.85, 95% CI: 1.05-3.24) were more likely to disclose their sexual orientation, whereas men who had sex with a female (AOR 0.19, 95% CI: 0.05-0.74) and had group sex (AOR 0.52, 95% CI: 0.30-0.89) were less likely to disclose their sexual orientation. Mental health status, HIV/STI infections were not associated with outness.Conclusions: GBM attending university who disclosed their sexual orientation were more likely to be involved with student work and less likely to engage in high-risk sexual behaviours. More attention and education could focus on non-disclosing GBM men attending university through peer education or other ways. [ABSTRACT FROM AUTHOR]

Factory workers make up a large proportion of China's internal migrants and may be highly susceptible to job and adaptation stress, negative affective states (e.g., depression and anxiety), and Internet gaming disorder (IGD). This cross-sectional study investigated the relationships between job stress, psychological adaptation, negative affective states and IGD among 1,805 factory workers recruited by stratified multi-stage sampling between October and December 2019. Structural equation modeling (SEM) was conducted to test the proposed mediation model. Among the participants, 67.3% were male and 71.7% were aged 35 years old or below. The prevalence of probable depression, probable anxiety, and IGD was 39.3, 28.7, and 7.5%. Being male, younger age, and shorter duration of living in Shenzhen were associated with higher IGD scores. Job stress was significantly associated with IGD (β = 0.11, p = 0.01) but not with negative affective states (β = 0.01, p = 0.77). Psychological adaptation was significantly associated with negative affective states (β = −0.37, p < 0.001) but not with IGD (β = 0.09, p > 0.05). Negative affective states were positively associated with IGD (β = 0.27, p < 0.001). The indirect effect of psychological adaptation (β = −0.10, p = 0.004) but not job stress (β = 0.003, p = 0.77) on IGD through negative affective states was statistically significant. The observed psychological correlates and mechanisms are modifiable, and can inform the design of evidence-based prevention programs for depression, anxiety, and IGD in this population. [ABSTRACT FROM AUTHOR]

Introduction: Social disruption associated with coronavirus disease 2019 (COVID‐19) threatens to impede access to regular healthcare, including for people living with HIV (PLHIV), potentially resulting in antiretroviral therapy (ART) interruption (ATI). We aimed to explore the characteristics and factors associated with ATI during the COVID‐19 outbreak in China. Methods: We conducted an online survey among PLHIV by convenience sampling through social media between 5 and 17 February 2020. Respondents were asked to report whether they were at risk of ATI (i.e. experienced ATI, risk of imminent ATI, threatened but resolved risk of ATI [obtaining ART prior to interruption]) or were not at risk of ATI associated with the COVID‐19 outbreak. PLHIV were also asked to report perceived risk factors for ATI and sources of additional ART. The factors associated with the risk of ATI were assessed using logistic regression. We also evaluated the factors associated with experienced ATI. Results: A total of 5084 PLHIV from 31 provinces, autonomous regions and municipalities in mainland China completed the survey, with valid response rate of 99.4%. The median age was 31 years (IQR 27 to 37), 96.5% of participants were men, and 71.3% were men who had sex with men. Over one‐third (35.1%, 1782/5084) reported any risk of ATI during the COVID‐19 outbreak, including 2.7% (135/5084) who experienced ATI, 18.0% (917/5084) at risk of imminent ATI and 14.4% (730/5084) at threatened but resolved risk. PLHIV with ATI were more likely to have previous interruptions in ART (aOR 8.3, 95% CI 5.6 to 12.3), travelled away from where they typically receive HIV care (aOR 3.0, 95% CI 2.1 to 4.5), stayed in an area that implemented citywide lockdowns or travel restrictions to control COVID‐19 (aOR 2.5, 95% CI 1.4 to 4.6), and be in permanent residence in a rural area (aOR 3.7, 95% CI 2.3 to 5.8). Conclusions: A significant proportion of PLHIV in China are at risk of ATI during the COVID‐19 outbreak and some have already experienced ATI. Correlates of ATI and self‐reported barriers to ART suggest that social disruptions from COVID‐19 have contributed to ATI. Our findings demonstrate an urgent need for policies and interventions to maintain access to HIV care during public health emergencies. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is associated with a substantial percentage of cervical cancer, and a significant percentage of anal, penile, vaginal, vulvar, oral cavity, oropharyngeal, and laryngeal cancers. Understanding the burden and trends of HPV-attributable cancers is crucial to HPV prevention strategies. In the current study, the authors estimated the latest burden and trends of HPV-attributable cancers in China.Methods: Data from the following sources were used. The number of new cancer cases and cancer deaths in China were estimated based on the China Cancer Registry Annual Report. The population-attributable fraction was estimated using pooled high-risk HPV prevalence and biomarker-positive rates, which were calculated using random effects meta-analyses. Cancer burden estimates were stratified by anatomic site, sex, and age.Results: In 2015, a total of 110,650 new cancer cases and 36,714 cancer deaths attributable to HPV infection were estimated to have occurred in China, of which cervical cancer accounted for 85.6% and 78.1%, respectively. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of HPV-attributable cancers were 5.63 and 1.81 per 100,000 person-years, respectively. The ASIR and ASMR both varied by anatomic site, with the highest rates noted for cervical cancer at 4.83 and 1.42 per 100,000 person-years, respectively. Between 2005 and 2015, the ASIR and ASMR demonstrated significant upward trends for all HPV-attributable cancers combined.Conclusions: Between 2005 and 2015, cervical cancer accounted for the vast majority of HPV-attributable cancers and its incidence and mortality increased rapidly in China. The comprehensive prevention of cervical cancer remains the most important target in the prevention of HPV-attributable cancers. [ABSTRACT FROM AUTHOR]

Objectives: Geosocial networking application specific to men who have sex with men (MSM) (gay app) has revolutionised the social networking of MSM globally, much concern was raised over its linkage to HIV/syphilis risk. This study sought to examine the association between use of gay app and sexual behaviours and HIV/syphilis risk among Chinese MSM.Methods: Eligible MSM were recruited through combined offline methods from 2015 to 2017 in Shenzhen, China, with data collected including demographics, sexual behaviours, app use, recreational drug use and HIV testing. All participants are required to sign a written informed consent and take a confidential HIV and syphilis testing.Results: The prevalence of app use among non-commercial MSM (NcMSM) has rapidly increased from 12.5% in 2015 to 52.6% in 2017. The primary four apps used were Blued (97.2%), Aloha (18.4%), Jack'd (14.1) and Zank (14.1%). After controlling for confounders, HIV prevalence was still significantly lower among app users than non-app users (adjusted odds ratios [AOR]: 0.77, 95% CI 0.61 to 0.97), yet the lower prevalence of syphilis was not significant (AOR: 0.97, 95% CI 0.76 to 1.23). App-using NcMSM were more likely to be younger, unmarried, self-identified as homosexuality and having higher education level and income than non-app-using NcMSM. App-using NcMSM had higher rate of consistent condom use and HIV testing, higher level of knowledge on HIV/AIDS prevention and condom use; however, they were more likely to have multiple sexual partners, practice receptive role in anal sex and use recreational drug.Conclusions: App-using NcMSM are more likely to have sexual risk behaviours as well as risk-reduction behaviours such as consistent condom use and HIV testing. Scaled-up and innovative venue-based HIV interventions are warranted for these high-risk MSM frequent social venues with less condom use and fewer HIV tests. Meanwhile, gay app should alternatively serve as an intervention and education platform for the MSM hard-to-reach via venue-based approaches. [ABSTRACT FROM AUTHOR]

Our study aimed to analyze genotype‐specific, age‐specific prevalence, and year‐on‐year trend of cervical human papillomavirus (HPV) detection among women in Guangdong, China 2008 to 2017. A total of 199 963 women attending the gynecological department and 11 999 women attending the medical examination center at Guangdong Women and Children Hospital were included. Prevalent HPV detection significantly differed between these two groups of women (20.16% vs 17.25%; P < .001). HPV genotypes of these two populations have a large overlap, with HPV52, 16, 58, CP8304, and 53 being the dominant subtypes among gynecological outpatients and HPV52, CP8304, 58, 53, and 16 among women receiving physical examinations. The distribution of prevalent HPV detection showed a bimodal pattern across age groups among these two populations. However, prevalent HPV detection among these two populations exhibited different trends from 2008 to 2017. Our study demonstrated that prevalent HPV detection among women in Guangdong is associated with age and different from that among women from other regions of China. Our study may provide valuable data to inform cervical cancer screening and HPV vaccination programs for women in this province. Highlight: This study summarized distribution characteristics and temporal trends of cervical HPV from large samples among gynecological outpatients and women receiving physical examinations in Guangdong of China during 2008‐2017. Prevalent HPV detection significantly differed among these two populations, but the dominant HPV subtypes have a large overlap, which can exactly provide a reference for the vaccine. Different trend curves of any HPV detection were observed among these two populations during 2008‐2017, which should be further investigated with more data from other hospitals and deserved closer attentions by public health specialists. Prevalent HPV detection among gynecological outpatients in the 20‐24 and >54 years old group both showed an upward trend during 2008‐2017, which can provide objective evidence for the selection of the younger age group for vaccination and provided clinical guideline for perimenopausal women in cervical cancer screening. [ABSTRACT FROM AUTHOR]

Our study aimed to assess the prevalent, incident, and persistent infection, and clearance of HPV among 19 753 individual women attending the gynecological department at a major comprehensive hospital. HPV 16, 52, and 58 ranked top three types with the highest prevalence and incidence. The prevalence of high‐risk (HR) HPV peaked among women aged 15 to 19 years, then sharply decreased with age, stabilized among women aged 25 to 44 years, and then surged again among women aged 45 years and older. HR HPV infection were more likely to be prevalent (15.9% vs 1.3%, P < 0.001), incident (17.3 vs 2.0 per 1000 person‐months, P < 0.001), and persistent (33.0% vs 24.2%, P = 0.033), and less likely to clear (88 vs 115 per 1000 person‐months, P = 0.040) compared to low‐risk HPV types. The majority of women detected with HR HPV types did not retest within 12 months. Clinical guidelines on HPV DNA testing are needed and education and counseling about HPV infection and its implications for women detected with HPV at clinical settings are warranted. [ABSTRACT FROM AUTHOR]

HPV DNA testing is receiving increasing popularity in cervical cancer screening. There is a lack of universal guidelines on HPV testing. Our study aimed to assess age-specific and year-on-year trend of HPV positivity and incidence and HPV retesting among 26,457 individual women attending the gynecological department at the First People's Hospital of Yunnan Province (FPHY) who had an HPV testing between January 1, 2012 and December 31, 2014. HPV 16, HPV 52, and cp8304 ranked among top 5 with regard to positivity in each year and overall incidence. The positivity of various HPV types peaked among women aged 15-19 years, then sharply decreased with age, stabilized among women aged 25-49 years and then surged again among women aged 50 years and older. The positivity of high-risk (HR) HPV types, including HPV 16, 18, 31, 33, 56 and 58, were on the rise during the time period ( P < 0.05 for all). HR HPV types tended to be more likely to persist than LR HPV types ( P < 0.05). Additionally, the incidence rate for any HR HPV type was also significantly higher than that for any LR HPV type (42.8 vs. 12.6 per 100 person-years, P < 0.001). The majority (57.3-77.5%) of women detected with HR HPV types did not retest within 12 months. Clinical guidelines on HPV DNA testing are needed and education, and counseling about HPV infection and its implications for women detected with HPV at clinical settings, are warranted. J. Med. Virol. 88:703-711, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction: Literature on the age at first anal intercourse (AFAI) among men who have sex with men (MSM) is limited. We aimed to elucidate the evolution of AFAI and the factors associated with early AFAI, based on a large sample of MSM in China. Methods: We collected information on the demographics and sexual behaviours of MSM from seven large cities in China from 2012 to 2013. Blood samples were collected for HIV serology. AFAI was calculated for MSM born in different time periods. Linear regression models were used to explore factors associated with younger AFAI. Results: A total of 4491 MSM (median age: 27 years, median AFAI: 21 years) were recruited. Median AFAI decreased steadily from 33 years of age among MSM born from 1940 to 1959 to 18 years of age among MSM born from 1990 to 1996. Factors significantly associated with younger AFAI included more recent birth cohort, being unmarried or living with a male partner, being a student or industry worker, the gender of the first partner being male, and using Rush or Ecstasy in the past six months (p for all B0.05). Conclusions: AFAI among MSM in China has considerably decreased over the past few decades. The decreasing AFAI and factors associated with younger AFAI point to the necessity of early sex education and control of recreational drug use among MSM in China. [ABSTRACT FROM AUTHOR]

Background: The new HIV treatment guidelines in China recommend antiretroviral therapy (ART) for all people living with HIV, but significant gaps in implementation still exist. Pre-exposure prophylaxis (PrEP) can effectively reduce the risk of HIV transmission among men who have sex with men (MSM). This study assessed the epidemiological impact and cost effectiveness of PrEP, enhanced biomedical interventions and their combination among MSM in China.Methods: A deterministic mathematical model was developed and projected over 20 years to assess the impact of the PrEP, biomedical interventions and their combinations. Incidence and prevalence of HIV were measured, and cost-effectiveness was assessed using incremental cost (international dollars, Int.$) per quality-adjusted life year (QALY) gained.Results: A total of 0.78 million new HIV infections were estimated to occur over the next 20 years if no additional interventions are implemented among MSM. The PrEP-only strategy covering 25-75% of HIV-negative high-risk MSM can prevent 0.09-0.20 million (12.1-25.7%) new infections, at a cost of 17,277-18,452 Int.$/QALY. The optimal cost-effectiveness path is from test-and-treat to the combination strategy of test-and-treat and PrEP. Some strategies could almost eliminate new HIV infections over the next 20 years.Conclusions: PrEP, test-and-treat, and their combinations among MSM are effective and cost-effective relative to current policy. PrEP is an important and cost-effective addition to current policy in China. [ABSTRACT FROM AUTHOR]

With the aging among people living with HIV, it is critical to understand the health needs of older adults (aged 50 years and above) living with HIV (OALHIV). Loneliness, as the next critical public health issue, was rarely mentioned among OALHIV. A multicenter cross-sectional study was conducted between April 2021 and April 2022. Participants were recruited from infectious diseases hospitals that provide HIV care in four cities in China. The associations with loneliness symptoms (measured by a three-item UCLA Loneliness Scale) were analyzed by logistic regression models. A total of 680 OALHIV (500 men, 180 women, mean age 60.3 ± 7.8 years) were included in the analysis. About one-fifth (18.1 %) of OALHIV reported loneliness symptoms. Living in urban areas (aOR 3.50, 95 % CI 1.76–6.95), having children without close intergenerational relationships (2.85, 1.15–7.07), higher self-perceptions of aging (1.10, 1.06–1.15), being heterosexual (0.26, 0.13–0.52) or bisexual (0.37, 0.16–0.82), having children with whom they kept close intergenerational relationships (0.36, 0.14–0.98), and reporting life satisfaction (0.40, 0.24–0.66), were associated with loneliness symptoms. This study is a cross-sectional study and only included OALHIV who participated in antiretroviral therapy treatment for >18 months, which is not widely representative. Loneliness was prevalent among OALHIV. Living in urban areas, being homosexual, having children with whom they kept fragile intergenerational relationships, being dissatisfied with life, and having higher self-perceptions of aging were independent risk factors for loneliness. Routine health management for OALHIV needs to incorporate the assessment of aging perceptions and loneliness. • Loneliness was prevalent among OALHIV (older adults living with HIV). • Living areas and aging perceptions influence loneliness among OALHIV. • Intergenerational relationships were associated with loneliness among OALHIV. • Life satisfaction is a protective factor for OALHIV against loneliness. • Understanding the prevalence of loneliness among OALHIV is crucial for intervention. [ABSTRACT FROM AUTHOR]

• We analyzed human papillomavirus (HPV) transmission among men who have sex with men (MSM) during the COVID-19 nonpharmaceutical interventions (NPIs). • HPV transmission among MSM changed during the implementation of COVID-19 NPIs. • The prevalence and incidence of HPV decreased during implementation of NPIs. • The clearance of HPV increased during implementation of NPIs. • The impact of COVID-19 NPIs on HPV may be due to disruption of sexual behavior. This study aimed to assess the effects of COVID-19 nonpharmaceutical interventions (NPIs) on the human papillomavirus (HPV) epidemic among men who have sex with men (MSM) in Xinjiang, China. In our cohort study, we enrolled and followed HIV-negative MSM in Xinjiang, China, between 2016 and 2022. Anal swab samples were collected to test for HPV DNA. We used interrupted time series analysis to characterize the temporal trends in HPV prevalence, incidence, and clearance before (September 01, 2016, to July 16, 2020) and during the implementation of COVID-19 NPIs in Xinjiang (July 17, 2020, to March 31, 2022). We used binomial segmented regression models to estimate the impact of COVID-19 NPIs on HPV prevalence, incidence, and clearance. We recruited 1296 MSM who contributed to a total of 5374 HPV tests in our study. COVID-19 NPIs were associated with a 37.9% decrease in the prevalence (prevalence ratio, 0.621; 95% confidence interval, 0.465-0.830), 52.2% decrease in the incidence (risk ratio, 0.478; 0.377-0.606), and 40.4% increase in the clearance (risk ratio, 1.404; 1.212-1.627) of HPV of any genotype after the implementation of COVID-19 NPIs in Xinjiang. COVID-19 NPIs may lead to lower transmission and higher clearance of HPV among MSM. Future studies are needed to clarify the longer-term impact of COVID-19 on the transmission and natural history of HPV among MSM. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: The effect of the COVID-19 epidemic on HIV self-testing (HIVST) remains unclear. We aimed to quantify the impact of COVID restrictions on HIVST kit purchasing behaviors in mainland China. Methods: Deidentified transaction data were retrieved from a large online shopping platform. An interrupted time series model was constructed to examine the impact of COVID restrictions on the weekly number of anonymous customers purchasing HIVST kits, online orders, and purchased kits. Results: A total of 2.32 million individuals submitted 4.46 million orders for 4.84 million HIVST kits between January 7, 2016, and April 22, 2020. Compared with expected levels, assuming COVID-19 epidemic and related restrictions had not happened, the number of purchasers, orders, and kits decreased by an estimated 10,500 (51.7%), 18,000 (55.3%), and 18,500 (54.9%) in the first week (January 23, 2020, to January 29, 2020) after COVID restrictions were implemented, respectively. As restrictions eased, the number of purchasers, orders, and kits increased by an average of 7.4%, 4.8%, and 4.9% per week, respectively. In the first week after COVID restrictions were lifted (April 9, 2020, to April 15, 2020), the number of purchasers returned to expected levels, whereas the number of orders and kits were still lower than expected levels. The impact of COVID restrictions on outcomes at the beginning of COVID restrictions and the increasing trends of outcomes were larger among those living in regions with higher COVID-19 incidence (eg, Wuhan city and Hubei province). Conclusions: Online sales of HIVST kits were significantly impacted by COVID restrictions, and HIVST kit purchasing patterns returned to expected levels after restrictions were lifted. [ABSTRACT FROM AUTHOR]

• Older adults underutilize sexual and reproductive health services in China. • Cervical cancer screening was not popular among older women in China. • Less than a third of sexually active older adults had sought help or advice for their sex life in the past year. • Identifying correlates of sexual and reproductive health services for older adults will be beneficial for informing policy development. Sexual and reproductive health (SRH) is critical to the overall health of older adults. We assessed the utilization of SRH services and its correlates among older adults in China. We recruited community-dwelling adults aged 50 and above in five Chinese cities between June 2020 and December 2022. In this study SRH services included reproductive health examination, cervical cancer screening, and sexual life counselling. Logistic regression was used to assess correlates of SRH services utilization. A total of 3001 older adults (1819 men and 1182 women) were enrolled. Among them, 11.4 % (343/3001) of participants received a reproductive health examination, 35.4 % (418/1182) of female participants received cervical cancer screening, and 30.1 % (401/1332) of sexually active participants sought help for their sexual lives. Older men with an annual income of USD 7500 or more (aOR = 3.21, 95%CI: 1.39–7.44), two or more chronic conditions (2.38, 1.39–4.08), and reproductive health problems (2.01, 1.18–3.43) were more likely to receive a urological examination. For older women, individuals who were younger (aged 50–59 years: 5.18, 2.84–9.43; aged 60–69 years: 2.67, 1.49–4.79), lived in an urban area (1.88, 1.31–2.71), were employed (1.73, 1.21–2.47), had two or more chronic conditions (2.04, 1.37–3.05), were sexually active (1.72, 1.15–2.58) and talked about sex (1.69, 1.21–2.36) were more likely to receive a gynecological examination. SRH services utilization among older adults was low, with urological examination among older men particularly low. SRH messages and services tailored for older adults are needed to enhance their utilization of SRH services. [ABSTRACT FROM AUTHOR]