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During acute respiratory infections, women may concurrently receive human papillomavirus (HPV) and respiratory vaccines, as observed during the coronavirus disease 2019 (COVID-19) pandemic in China. However, few studies have assessed the safety of such concurrent administration, which could impact HPV vaccination schedules. This study analyzes the safety and optimal sequence of concurrent HPV and COVID-19 vaccinations. For this purpose, we surveyed women with both vaccines from January to October 2023 in Fujian Province, China. During this process, we collected vaccination history and adverse event (AE) data via telephone or interviews. Participants were grouped as Before, Concurrent, or After based on their vaccination sequence. A Chi-squared test, exact Fisher tests, and logistic regression were used to analyze the incidence of AEs and factors influencing vaccine safety. Overall, 1416 eligible participants were included. Although overall AE risk with the HPV vaccine was unaffected by vaccination sequence, individual AEs varied statistically between groups, including pain at the vaccination site (p < 0.001) and prolonged menstruation duration (p = 0.003). Based on the results, the optimal sequence would be to receive the HPV vaccine after the COVID-19 vaccine (After group). This insight may guide future emergency vaccination sequences for HPV and other respiratory infectious diseases. [ABSTRACT FROM AUTHOR]

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]

Non-occupational post-exposure prophylaxis (nPEP) is recommended to reduce the likelihood of HIV infection after potential exposure. However, little is known about this practice among Chinese gay, bisexual and other men who have sex with men (GBM). GBM were enrolled from both centers for disease prevention and control (CDCs) and community health centers in six cities in China. Multivariable logistics regression was used to assess factors associated with awareness of and willingness to use nPEP. A total of 516 eligible GBM were included, 67.2% of whom were aware of nPEP, 76.0% were willing to use nPEP, and 2.3% had ever used nPEP. GBM who had college or higher education, had disclosed sexual orientation, had increased number of male sex partners in the last 6 months, and had ever tested for HIV were more likely to be aware of nPEP. Willingness to use nPEP was significantly associated with college or higher education, STI history, gay app use, and awareness of nPEP prior to study. Uptake of nPEP is still low among MSM in China. Efforts are needed to improve awareness of and access to nPEP among GBM, especially those at higher risk of HIV infection. [ABSTRACT FROM AUTHOR]

Background: Among people living with HIV (PLHIV) on antiretroviral therapy (ART), the mortality of immunological non-responders (INRs) is higher than that of immunological responders (IRs). However, factors associated with immunological non-response following ART are not well documented. Methods: We obtained data for HIV patients from the National Free Antiretroviral Treatment Program database in China. Patients were grouped into IRs (CD4 cell count ≥ 350 cells/μl after 24 months' treatment), immunological incomplete responders (ICRs) (200–350 cells/μl) and INRs (< 200 cells/μl). Multivariable logistic regression was used to assess factors associated with immunological non-response. Results: A total of 3900 PLHIV were included, among whom 2309 (59.2%) were IRs, 1206 (30.9%) ICRs and 385 (9.9%) INRs. In multivariable analysis, immunological non-response was associated with being male (2.07, 1.39–3.09), older age [40–49 years (vs. 18–29 years): 2.05, 1.29–3.25; 50–59 years: 4.04, 2.33-7.00; ≥ 60 years: 5.51, 2.84–10.67], HBV co-infection (1.63, 1.14–2.34), HCV co-infection (2.01, 1.01–4.02), lower CD4 + T cell count [50–200 cells/μl (vs. 200–350 cells/μl): 40.20, 16.83–96.01; < 50 cells/μl: 215.67, 85.62-543.26] and lower CD4/CD8 ratio (2.93, 1.98–4.34) at baseline. Compared with patients treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) based regimens, those receiving protease inhibitors (PIs) based regimens were less likely to be INRs (0.47, 0.26–0.82). Conclusions: We found a sizable immunological non-response rate among HIV-infected patients. Being male, older age, coinfection with HBV and HCV, lower CD4 + T cell count and lower CD4/CD8 ratio are risk factors of immunological non-response, whereas PIs-based regimens is a protective factor. [ABSTRACT FROM AUTHOR]

Background and aims: The end of the zero-COVID-19 policy placed a large number of older adults in China at increased risk of COVID-19 infection. SARS-CoV-2 rapid antigen testing (RAT) is a promising tool for scaling up testing and ensuring that patient management and public health measures can be implemented without delay. We aimed to understand the knowledge and willingness of RAT, and its correlates among older adults in China. Methods: A nationwide cross-sectional survey on knowledge and willingness about RAT among older adults in China was conducted between January 14 and 28, 2023, shortly after the end of the zero-COVID-19 policy. An online questionnaire was used to collect information on sociodemographic characteristics, health characteristics, sources to access RAT information, and attitudes toward COVID-19 and its RAT. Logistic regression was used to assess correlates of knowledge of RAT and willingness to take RAT among older adults. Results: A total of 1030 older adults (494 women and 536 men, mean age 68.7 ± 7.0 years) were recruited. 49.4% of the participants had a high level of RAT knowledge. After adjusting for sociodemographic characteristics, chronic diseases (0.70, 0.49–0.99), learning RAT from new media (5.46, 3.48–8.68) and traditional media (3.35, 2.13–5.34), and perceiving RAT as convenient (4.03, 2.80–5.85) were associated with levels of RAT knowledge. 53.3% of the participants were willing to take RAT. After adjusting for sociodemographic characteristics, learning RAT from new media (8.46, 5.26–14.0) and traditional media (1.63, 1.04–2.55), perceiving RAT as convenient (2.97, 2.10–4.22), and worrying about (re)infection with COVID-19 (2.12, 1.55–2.92) were associated with willingness to take RAT. Conclusion: The levels of RAT knowledge and willingness to take RAT among older adults in China may hinder the scale-up of RAT. Health education about RAT should be strengthened among older adults. Special efforts should be made to integrate traditional and new media to promote RAT among older adults, specifically, for virus susceptibility and the convenience of RAT. Given the reopening of society, our study could inform our response to future novel infectious diseases and aid in the timely scale-up of RAT. [ABSTRACT FROM AUTHOR]

Despite the proven virological advantages, there remains some controversy regarding whether first-line integrase strand transfer inhibitors (INSTIs)-based antiretroviral therapy (ART) contributes to reducing mortality of people living with HIV (PLHIV) in clinical practice. Here we report a retrospective study comparing all-cause mortality among PLHIV in China who were on different initial ART regimens (nevirapine, efavirenz, dolutegravir, lopinavir, and others [including darunavir, raltegravie, elvitegravir and rilpivirine]) between 2017 and 2019. A total of 41,018 individuals were included across China, representing 21.3% of newly reported HIV/AIDS cases collectively in the country during this period. Only the differences in all-cause mortality of PLHIV between the efavirenz group and the nevirapine group, the dolutegravir group and the nevirapine group, and the lopinavir group and the nevirapine group, were observed in China. After stratifying the cause of mortality, we found that the differences in mortality between initial ART regimens were mainly observed in AIDS-related mortality. First-line integrase strand transfer inhibitors are commonly used for people with HIV. Here, Wu et al. report results from a multicenter cohort study in China observing significant differences in all-cause mortality among patients between various treatment groups. [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 HIV‐1 pandemic has persisted for four decades, and poses a major challenge to global public health. Shenzhen, a city with large number of migrant populations in China, is suffering HIV‐1 epidemic. It is necessary to continuously conduct the molecular surveillance among newly diagnosed HIV‐1 patients in these migrant population. In this study, plasma samples of newly diagnosed and ART‐naive HIV‐1 infections were collected from Shenzhen city in China. The partial genes of HIV‐1 gag and pol were amplified and sequenced for the analysis of genotype, drug resistance, and molecular transmission network. Ninety‐one sequences of pol gene were obtained from newly diagnosed HIV‐1 infections in Shenzhen, and seven HIV‐1 subtypes were revealed in this investigation. Among them, the circulating recombinant form (CRF) 07_BC was the mostly frequent subtype (53.8%, 49/91), followed by CRF01_AE (20.9%, 19/91), CRF55_01B (9.9%, 9/91), unique recombinant forms (URFs) (8.8%, 8/91), B (3.3%, 3/91), CRF59_01B (2.2%, 2/91), and CRF08_BC (1.1%, 1/91). The overall prevalence of pretreatment drug resistance (PDR) was 23.1% (21/91), and 52.38% (11/21) of the PDR was specific for the nonnucleotide reverse transcriptase inhibitors (NNRTIs). Furthermore, a total of 3091 pol gene sequences were used to generate 19 molecular transmission clusters, and then one growing cluster, a new cluster, and a cluster with growth reactivation were identified. The result revealed that more sexual partner, CRF_07BC subtype, and seven amino acid deletions in gag p6 region might be the influencing factors associated with the high risk of transmission behavior. Compared with CRF01_AE subtype, CRF07_BC subtype strains were more likely to form clusters in molecular transmission network. This suggests that long‐term surveillance of the HIV‐1 molecular transmission should be a critical measure to achieve a precise intervention for controlling the spread of HIV‐1 in China. [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]

Background: To estimate crude mortality, excess mortality, and standardized mortality rates (SMR) among people living with HIV (PLHIV) initiating highly active antiretroviral therapy (HAART) in Luzhou, China 2006–2020, and assess associated factors. Methods: PLHIV initiating HAART in the HIV/AIDS Comprehensive Response Information Management System (CRIMS) in Luzhou, China 2006–2020 were included in the retrospective cohort study. The crude mortality, excess mortality, and SMR were estimated. Multivariable Poisson regression model was used for analyzing risk factors associated with excess mortality rates. Results: The median age among 11,468 PLHIV initiating HAART was 54.5 years (IQR:43.1–65.2). The excess mortality rate decreased from 1.8 deaths/100 person-years (95% confidence interval [CI]:1.4–2.4) in 2006–2011 to 0.8 deaths/100 person-years (95%CI:0.7–0.9) in 2016–2020. SMR decreased from 5.4 deaths/100 person-years (95%CI:4.3–6.8) to 1.7 deaths/100 person-years (95%CI:1.5–1.8). Males had greater excess mortality with the eHR of 1.6 (95%CI:1.2–2.1) than females. PLHIV with CD4 counts ≥ 500 cells/μL had the eHR of 0.3 (95%CI:0.2–0.5) in comparison to those with CD4 counts < 200 cells/μL. PLHIV with WHO clinical stages III/IV had greater excess mortality with the eHR of 1.4 (95%CI:1.1–1.8). PLHIV with time from diagnosis to HAART initiation ≤ 3 months had the eHR of 0.7 (95%CI:0.5–0.9) compared to those with time ≥ 12 months. PLHIV with initial HAART regimens unchanged and viral suppression had the eHR of 1.9 (95%CI:1.4–2.6) and 0.1 (95%CI:0.0–0.1), respectively. Conclusions: The excess mortality and SMR among PLHIV initiating HAART in Luzhou, China decreased substantially from 2006 to 2020, but the mortality rate among PLHIV was still higher than general population. PLHIV who were male, with baseline CD4 counts less than 200 cells/μL, WHO clinical stages III/IV, time from diagnosis to HAART initiation ≥ 12 months, initial HAART regimens unchanged, and virological failure had a greater risk of excess deaths. Early and efficient HAART would be significant in reducing excess mortality among PLHIV. [ABSTRACT FROM AUTHOR]

Introduction: Internal migrant workers have a great chance to experience defeat due to their low social status and economic situation. It has been reported that defeat might play a prospective role in predicting depression and anxiety; however, defeat is rarely explored among internal migrant workers due to the lack of appropriate measurement scales. The defeat scale (DS) can measure the feeling of defeat, social hierarchy reduction, and loss in social struggle. But its reliability and validity among internal migrant workers have not been reported. This study aimed to verify the content validity and structural validity of the DS among internal migrant workers in China and to explore its correlations with anxiety and depression. Methods: 1805 internal migrant workers (IMWs) were recruited by stratified multistage sampling from 16 factories in Shenzhen, China. The content validity index (CVI) was used to assess content validity. Cronbach's coefficient alpha of each factor and the total scale were calculated to assess the reliability of DS. The scree test was used to determine the number of factors. Convergent validity and discriminant validity were estimated by calculating the average variance extracted and composite reliability. Logistic regression was performed to explore the effects of DS scores on anxiety and depression. Results: Mean score of DS among IMWs was 18.42 ± 9.40. There were 606 (33.6%) IMWs who were considered to have depression symptoms, and 524 (29.0%) IMWs were considered to have anxiety symptoms. A two-factor model was obtained and fitted well (CFI = 0.956, GFI = 0.932, IFI = 0.956, RMSEA = 0.068, SRMR = 0.052). Cronbach's alpha reliability coefficient for the DS was 0.92. Logistic regression showed that DS scores were positively associated with anxiety and depression among IMWs. Conclusions: DS performed well among IMWs on content validity and structural validity, and it was suitable as a measurement instrument to assess defeat among this population. Defeat was positively associated with anxiety and depression and might play an important role in the mental health of IMWs. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men (MSM) living with HIV make up the majority of cases in the current Mpox outbreak. We aimed to investigate the perception of and vaccine readiness towards Mpox among MSM living with HIV in China. Methods: This cross-sectional online study was conducted from 10 August to 9 September 2022. Participants responded to survey questions about their socio-demographic information, HIV status, sexual behaviors, knowledge of Mpox, and attitudes towards Mpox vaccines. Results: A total of 577 MSM living with HIV participated in the study. A total of 37.6% expressed concerns about the Mpox epidemic in China, and 56.8% were willing to get the Mpox vaccine. Men who had > four sexual partners in the previous three months (aOR = 1.9 95% CI: 1.2–2.8 Ref: 0), had close contact with > four individuals in a day (3.1, 1.5–6.5 Ref: 0–3), were worried about the Mpox epidemic in China (1.6, 1.1–2.3 Ref: No), and believed that Mpox vaccines are safe (6.6, 2.7–16.4 Ref: No or not sure) and effective (1.9, 1.1–3.3 Ref: No) for people living with HIV were more likely to be willing to get the Mpox vaccine. MSM living with HIV with a high school education or below (0.5, 0.3–0.9 Ref: Postgraduate diploma), and sometimes (0.5, 0.3–0.8 Ref: Often), seldom, or never (0.5, 0.3–0.9 Ref: Often) followed news about Mpox were unwilling to get the Mpox vaccine. Conclusion: The ongoing Mpox pandemic has not attracted widespread concerns among MSM living with HIV in China. Having more sexual partners and close contacts, worrying about the Mpox epidemic, and believing in the vaccine's safety and efficacy were predictors of their willingness to get the Mpox vaccine. Efforts should be made to raise awareness of the potential risk of Mpox in this at-risk population. Public health strategies should fully address predictors of vaccination willingness. [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]

With a large population most susceptible to Omicron and emerging SARS‐CoV‐2 variants, China faces uncertain scenarios if reopening its border. Thus, we aimed to predict the impact of combination preventative interventions on hospitalization and death. An age‐stratified susceptible‐infectious‐quarantined‐hospitalized‐removed‐susceptible (SIQHRS) model based on the new guidelines of COVID‐19 diagnosis and treatment (the ninth edition) was constructed to simulate the transmission dynamics of Omicron within 365 days. At baseline, we assumed no interventions other than 60% booster vaccination in individuals aged ≤60 years and 80% in individuals aged >60 years, quarantine and hospitalization. Oral antiviral medications for COVID‐19 and nonpharmaceutical interventions (NPIs) such as social distancing and antigen self‐testing were considered in subsequent scenarios. Sensitivity analyses were conducted to reflect different levels of interventions. A total of 0.73 billion cumulative quarantines (95% CI 0.53–0.83), 33.59 million hospitalizations (22.41–39.31), and 0.62 million deaths (0.40–0.75) are expected in 365 days. The case fatality rate with pneumonia symptoms (moderate, severe and critical illness) is expected to be 1.83% (1.68–1.99%) and the infected fatality rate is 0.38‰ (0.33–0.4‰). The highest existing hospitalization and ICU occupations are 3.11 (0.30–3.85) and 20.33 (2.01–25.20) times of capacity, respectively. Sensitivity analysis showed that interventions can be adjusted to meet certain conditions to reduce the total number of infections and deaths. In conclusion, after sufficient respiratory and ICU beds are prepared and the relaxed NPIs are in place, the SARS‐CoV‐2 Omicron variant would not seriously impact the health system. [ABSTRACT FROM AUTHOR]

Compared with the nucleic acid amplification test (NATT), the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) rapid antigen self‐testing (RAST) has advantages in speed and convenience. However, little is known about people's acceptance and influencing factors for SARS‐CoV‐2 RAST. A cross‐sectional study was conducted from April 21 to 30, 2022 in China. The χ2 test and multivariate logistic regressions were used to identify the influencing factors. The structural equation model was used to test the extended protective motivation theory (PMT) model hypotheses. Among the total of 5107 participants, 62.5% were willing to accept the SARS‐CoV‐2 RAST. There were significant differences in acceptance among different residences (p < 0.001), educational level (p < 0.001), occupation (p < 0.001), monthly income (p < 0.001), travel frequency (p < 0.05), and feelings about NATT (p < 0.001). Response efficacy (β = 0.05; p = 0.025) and self‐efficacy (β = 0.84; p < 0.001) had a positive effect, while response cost showed a negative effect (β = −0.07; p < 0.001). The public's major concerns about SARS‐CoV‐2 RAST are its reliability, testing method, price, and authority. Overall, a moderate intention to use SARS‐CoV‐2 RAST was found among the Chinese population. The extended PMT can be used for the prediction of intention to accept the RAST. We need to take measures to increase people's acceptance of SARS‐CoV‐2 RAST. [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]

HIV-1 CRF07_BC-p6Δ7, a strain with a seven amino acid deletion in the p6 region of the Gag protein, is becoming the dominant strain of HIV transmission among men who have sex with men (MSM) in China. Previous studies demonstrated that HIV-1 patients infected by CRF07_BC-p6Δ7 strain had lower viral load and slower disease progression than those patients infected with CRF07_BC wild-type strain. However, the underlying mechanism for this observation is not fully clarified yet. In this study, we constructed the recombinant DNA plasmid and adenovirus type 2 (Ad2) vector-based constructs to express the HIV-1 CRF07_BC Gag antigen with or without p6Δ7 mutation and then investigated their immunogenicity in mice. Our results showed that HIV-1 CRF07_BC Gag antigen with p6Δ7 mutation induced a comparable level of Gag-specific antibodies but stronger CD4+ and CD8+ T-cell immune responses than that of CRF07_BC Gag (07_BC-wt). Furthermore, we identified a series of T-cell epitopes, which induced strong T-cell immune response and cross-immunity with CRF01_AE Gag. These findings implied that the p6Gag protein with a seven amino acid deletion might enhance the Gag immunogenicity in particular cellular immunity, which provides valuable information to clarify the pathogenic mechanism of HIV-1 CRF07_BC-p6Δ7 and to develop precise vaccine strategies against HIV-1 infection. [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]

(1) Background: We conducted a prospective observational cohort study to measure incidence, persistence, and clearance of anal human papillomavirus (HPV) among men who have sex with men (MSM) in China. (2) Methods: MSM were recruited in Guangzhou, Shenzhen and Wuxi, China in 2017. A tablet-based questionnaire was used to collect sociodemographic and behavioral characteristics. An anal brush sample was collected for HPV testing and genotyping. Participants were followed up 12 months after enrolment. (3) Results: A total of 196 participants completed two HPV tests with a median age of 27.3 (interquartile range (IQR) 24.0–32.8) years. Rate of incidence, persistence, and clearance for HPV among MSM were 31.3 (95% confidence interval (CI) 24.7–39.2), 47.9 (36.8–61.3), and 122.5 (104.3–143.0) per 1000 person months (pm), respectively. HPV 16 (4.1/1000 pm) had the highest incidence rate, and HPV 6 (47.4/1000 pm) had the highest persistence rate. Having lower education and engaging in receptive anal intercourse were potential risk factors of HPV incidence. A higher incidence rate was observed among younger MSM. (4) Conclusions: The high incidence and low clearance of anal HPV highlight the necessity of HPV vaccination among MSM. Further studies are needed to clarify the HPV dynamics at multiple anatomical sites and the burden of HPV-related diseases among MSM. [ABSTRACT FROM AUTHOR]

Recent evidence shows that circumcision is associated with lower HIV prevalence among MSM. We assessed the acceptability of circumcision for preventing HIV and that of Shang Ring circumcision (SRC) among men who have sex with men (MSM) in China. 538 adult MSM were recruited from six cities in China between January and March 2019. Participants were surveyed by an online, self-administered questionnaire. The acceptability of circumcision was assessed before and after the potential protective effect of circumcision against HIV was informed, and subsequently men's willingness to undergo SRC was assessed. The level of circumcision was 16.4%. Of 450 uncircumcised MSM, their willingness to be circumcised in the following six months increased significantly from 32.2% to 55.6% after the information session. Three quarters of men who were willing to undergo circumcision accepted SRC. MSM who perceived that circumcision could maintain genital hygiene were more likely to accept circumcision after the information session, whereas those who regarded circumcision as an embarrassing surgery were disinclined to be circumcised. The low circumcision rate, along with its high acceptability in Chinese MSM, suggests a great potential benefit of circumcision intervention if proved effective. SRC might be a popular circumcision procedure in this population. [ABSTRACT FROM AUTHOR]

Background: Migrant workers are a group susceptible for depression evolution due to occupational maladaptive triggers. The social rank theory illustrates the pathology process from defensive adaptation to depression, pointing out the early prevention of depression by discovering entrapment. This study aims to reveal the relationship between migrant workers' entrapment and depressive symptoms. Methods: A total of 1805 migrant workers in Shenzhen were recruited by stratified multi-stage sampling. Sample's demographic, behavioral and psychosocial characteristics were described and analyzed to reveal the relationship between entrapment and depressive symptoms. The Receiver Operator Characteristic was performed to find the optimal cut-off point of Entrapment Scale for predicting depressive symptoms. Results: In the binary logistic regression of sociodemographic variables, migrant workers who were married (univariate odds ratio (ORu) = 0.69, 95% Confidence Interval (CI) = 0.56–0.84), owned 1 or 2 children (ORu = 0.71, 95% CI = 0.58–0.86), had been working over 10 years (ORu = 0.71, 95% CI = 0.54–0.95), earned > 4999 yuan per month (ORu = 0.68, 95% CI = 0.47–0.99; multivariate odds ratio (ORm) = 0.57, 95% CI = 0.38–0.87) or with low risks of alcohol use disorders (ORu = 0.51, 95% CI = 0.34–0.75) had lower risks of depressive symptoms. After adjusted the aforementioned significant sociodemographic variables, migrant workers with severer entrapment were more likely to have depressive symptoms (adjusted odds ratio (ORa) = 1.13, 95% CI = 1.12–1.15). Besides, the study proved the reliability and validity of the Chinese version Entrapment Scale, preferring a two-dimensional structure, and 11 was the optimal cut-off value of this scale for predicting depressive symptoms among migrant workers. Conclusions: This result indicates the potential value of entrapment according to the social rank theory on facilitating early prevention of migrant works' depression and the application value of Entrapment Scale for effectively measuring mental status among migrant workers. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has affected antiretroviral therapy (ART) continuity among people living with HIV (PLHIV) worldwide. We conducted a qualitative study to explore barriers to ART maintenance and solutions to ART interruption when stringent COVID‐19 control measures were implemented in China, from the perspective of PLHIV and relevant key stakeholders. Methods: Between 11 February and 15 February 2020, we interviewed PLHIV, community‐based organization (CBO) workers, staff from centres for disease control and prevention (CDC) at various levels whose work is relevant to HIV care (CDC staff), HIV doctors and nurses and drug vendors from various regions in China. Semi‐structured interviews were conducted using a messaging and social media app. Challenges and responses relevant to ART continuity during the COVID‐19 pandemic were discussed. Themes were identified by transcript coding and mindmaps. Results: Sixty‐four stakeholders were recruited, including 16 PLHIV, 17 CBO workers, 15 CDC staff, 14 HIV doctors and nurses and two drug vendors. Many CDC staff, HIV doctors and nurses responsible for ART delivery and HIV care were shifted to COVID‐19 response efforts. Barriers to ART maintenance were (a) travel restrictions, (b) inadequate communication and bureaucratic obstacles, (c) shortage in personnel, (d) privacy concerns, and (e) insufficient ART reserve. CBO helped PLHIV maintain access to ART through five solutions identified from thematic analysis: (a) coordination to refill ART from local CDC clinics or hospitals, (b) delivery of ART by mail, (c) privacy protection measures, (d) mental health counselling, and (e) providing connections to alternative sources of ART. Drug vendors contributed to ART maintenance by selling out‐of‐pocket ART. Conclusions: Social and institutional disruption from COVID‐19 contributed to increased risk of ART interruption among PLHIV in China. Collaboration among key stakeholders was needed to maintain access to ART, with CBO playing an important role. Other countries facing ART interruption during current or future public health emergencies may learn from the solutions employed in China. [ABSTRACT FROM AUTHOR]

Background: CRF55_01B is a newly identified HIV-1 circulating recombinant form originated from MSM in China. However, its impact on the disease progression and transmission risk has not been investigated. This study aimed to determine the impact of CRF55_01B infection on viral dynamics and immunological status so as to provide scientific evidence for further control and prevention effort on CRF55_01B. Linear mixed effect models were applied to evaluate CD4 cell count decline and viral load increase by subtype. Results: Of the 3418 blood samples, 1446 (42.3%) were CRF07_BC, 1169 (34.2%) CRF01_AE, 467 (13.7%) CRF55_01B, 249 (7.3%) type B, and 87 (2.5%) other subtypes (CRF_08BC, CRF_01B, C). CRF55_01B had become the third predominant strain since 2012 in Shenzhen, China. CRF55_01B-infected MSM showed lower median of CD4 count than CRF07_BC-infected MSM (349.5 [IQR, 250.2–474.8] vs. 370.0 [IQR, 278.0–501.0], P < 0.05). CRF55_01B infection was associated with slower loss of CD4 count than CRF01_AE (13.6 vs. 23.3 [cells/µl]¹/²/year, P < 0.05)among MSM with initial CD4 count of 200–350 cells/µl. On the other hand, those infected with CRF55_01B showed higher median plasma HIV RNA load (5.4 [IQR, 5.0–5.9]) than both CRF01_AE (5.3 [IQR, 4.8–5.7], P < 0.05) and CRF07_BC (5.0 log10 [IQR, 4.5–5.5], P < 0.001) at the initiation of antiretroviral therapy. Furthermore, the annual increasing rate of viral load for CRF55_01B infection was significantly higher than that of CRF07_BC (2.0 vs. 0.7 log10 copies/ml/year, P < 0.01). Conclusions: The relatively lower CD4 count and faster increase of plasma HIV RNA load of CRF55_01B-infected MSM without antiretroviral therapy suggest that CRF55_01B may lead to longer asymptomatic phase and higher risk of HIV transmission. Strengthened surveillance, tailored prevention strategies and interventions, and in-depth research focusing on CRF55_01B are urgently needed to forestall potential epidemic. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) infection among men who have sex with men (MSM) in China is underreported. We performed a systematic review and meta-analysis to clarify site-specific HPV prevalence among MSM in China. We searched both English and Chinese databases for all studies published before April 1, 2020, that reported HPV prevalence among MSM in China. Random-effects meta-analysis was used to calculate summary estimates. Thirty-four articles were eligible, where 32, 5, and 2 articles reported HPV prevalence at the anus, penis, and oral cavity, respectively. The estimated prevalence of anal HPV among MSM in China was 85.1% (HIV-positive), 53.6% (HIV-negative), and 59.2% (unknown HIV status), with HPV genotypes being predominated by HPV 6, 11, 16, 18, 52, and 58. Any HPV and high-risk (HR) HPV was more common in northern China, while low-risk HPV was more common in southern China. HPV prevalence increased with age among HIV-negative MSM, from 40.5% (aged < 20 years) to 57.2% (aged ≥ 40 years). High prevalence of any HPV (HIV+: 95.1%; HIV−: 97.7%) and multiple infections (HIV+: 75.9%; HIV−: 41.7%) was found in anogenital warts among MSM. HPV is common among MSM in China. MSM living with HIV and/or anogenital warts were at disproportionate risk for HR HPV. Younger MSM were found to have a lower HPV prevalence. HPV vaccines would have prevented the majority of infections if given before sex debut. HPV at anatomical sites other than the anus, incident HPV infection, and the cost-effectiveness of HPV vaccination in this population are worth further investigation. [ABSTRACT FROM AUTHOR]

Background: The prevalence of HIV among men who have sex with men (MSM) in southwest China is still increasing. This study aimed to investigate the trend in HIV incidence and its associated risk factors among MSM in Chengdu, China.Method: Incidence data were collected from the largest local non-governmental organization (NGO) serving MSM in Chengdu between 2012 and 2018, while information on sexual behaviors was collected from 2014. All MSM who received voluntary counseling and testing services (VCT) in the collaborating NGO at least twice during the study period were included. We calculated the HIV incidence density among MSM every 2 years and the overall incidence rate. A Cox proportional hazards regression model was employed to identify risk factors for HIV infection.Result: A total of 4578 HIV-negative participants were included in the cohort. The total incidence density was 5.95 (95% CI: 5.37-6.56)/100 person-years (PYs) between 2012 and 2018. The segmented incidence density was 9.02 (95% CI: 7.46-10.78), 5.85 (95% CI: 4.86-6.97), 5.43 (95% CI: 4.53-6.46), and 3.09 (95% CI: 2.07-4.41)/100 PYs in 2012-2013, 2014-2015, 2016-2017, and 2018, respectively. After adjusting for sociodemographic characteristics, compared to participants without sexual partners within 6 months, MSM with one fixed partner (Adjusted Hazard Ratio, AHR = 1.18, 95% CI: 0.44-3.19) and more than five partners (AHR = 2.24, 95% CI: 0.81-6.20) had increased risk of HIV infection. MSM who used condom inconsistently had a higher risk of HIV infection (AHR = 1.87, 95% CI: 1.46-2.38) compared to consistent condom users.Conclusion: The decreased HIV incidence density among MSM was potentially related to the successful comprehensive HIV prevention strategies in Chengdu. Multiple male sexual partnerships and inconsistent condom use during anal intercourse were risk factors associated with HIV occurrence. [ABSTRACT FROM AUTHOR]

This study is aimed at investigating the awareness of and preferences for oral and long-acting injectable HIV preexposure prophylaxis (PrEP) and their associated factors among men who have sex with men (MSM) at high risk of HIV infection in southern China. A cross-sectional survey was conducted among 603 MSM who were recruited through a cohort study called the T2T Study at three sexual health clinics in Guangzhou, Shenzhen, and Wuxi, China, from 2017 to 2018. We collected information on HIV-negative participants' awareness of and willingness to use PrEP and its potential correlations. Univariate and multivariate logistic regressions were used for data analyses. A total of 550 HIV-negative MSM were enrolled in the study. Less than half of at-risk MSM (43.1%) had heard of PrEP before, and the rate of overall willingness to use PrEP was 65.8%, while MSM were more willing to use daily oral PrEP than long-acting injectable- (LAI-) PrEP (62.2% vs. 38.5%). MSM who had university degrees or above (aOR = 1.55 , 95% CI: 1.01-2.37), used condoms during last anal sex (1.52, 1.01-2.29), and tested 3 times or more for HIV (2.45, 1.10-5.47) were more likely to be aware of PrEP. MSM who had use of gay dating apps (1.51, 1.02-2.23), ever participated in HIV- or sexually transmitted disease (STD-) related studies (1.91, 1.24-2.94), and had heard of PrEP (3.06, 2.06-4.54) were more willing to use any regimen of PrEP. MSM at high risk of HIV infection had low awareness of PrEP and moderate willingness to use PrEP. Further studies of the implementation and promotion of PrEP targeting at-risk MSM should be performed. [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 Rectal douching, which is a common practice among men who have sex men (MSM) as a preparation for anal sex, may potentially increase the risk of HIV infection. However, little is known about the practice of rectal douching among Chinese MSM. This study investigated the characteristics of rectal douching and factors associated with rectal douching.Methods: Between January and March 2019, MSM aged ≥18 years in six cities in China were recruited to the study. Participants were asked to complete a self-administered online questionnaire. Chi-squared tests and multivariable logistic regression were used to examine factors associated with rectal douching by calculating odds ratios (ORs) and 95% confidence intervals (CIs).Results: Of 485 MSM in this study, 278 (57.3%) practiced rectal douching in the preceding 6 months. The most common reasons for douching before and after anal sex were hygiene/cleanliness (78.6% and 66.1% respectively) and HIV/STI prevention (8.5% and 17.4% respectively). The most used enemas and equipment before and after anal sex were tap water (73.5% and 70.2% respectively) and showerhead hoses (76.1% and 75.2% respectively). Men who engaged in both insertive and receptive anal sex (OR 8.84; 95% CI 4.52-17.30), exclusively receptive anal sex (OR 6.56; 95% CI 3.55-12.13), condom-less anal intercourse (OR 1.64; 95% CI 1.03-2.63) and anal sex after alcohol use (OR 1.54; 95% CI 1.00-2.35) were more likely to perform douching.Conclusion: Rectal douching is common in MSM, some of whom may not realise the potential risks associated with douching. The co-occurrence of douching and other high-risk behaviours would make MSM more vulnerable to HIV. Health education aimed at informing MSM of the potential risks and addressing the high prevalence of douching are urgently needed. [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]

Background: The incidence of anal squamous cell carcinoma (SCC) has been steadily growing globally in the past decade. Clinical data on anal SCC from China are rare. We conducted this study to describe the clinical and epidemiological characteristics of anal SCC in China and explore prognostic factors of outcomes among patients with anal SCC.Methods: We audited demographic characteristics, relevant symptoms, risk factors, treatment modalities and outcomes for patients diagnosed with anal SCC at 11 medical institutions in China between January 2007 and July 2018.Results: A total of 144 patients (109 females) were diagnosed with SCC during this period. Median age at initial diagnosis was 52.0 (interquartile range: 46.0-61.8) years. The most common symptoms were bleeding (n = 93, 64.6%), noticing a lump (n = 49, 34.0%), and pain (n = 47, 32.6%). The proportion of patients at the American Joint Committee on Cancer (AJCC) stages I-IV were 10 (6.9%), 22 (15.3%), 61 (42.4%) and 8 (5.6%), respectively, and AJCC stages in 43 (29.9%) patients were unknown. Thirty-six patients (25.0%) underwent abdominoperineal resection initially. Univariable analysis showed that T stage predicted recurrence-free survival (RFS) (Hazard ratio [HR] = 3.03, 95% Confidence interval [CI]: 1.10-8.37, p = 0.032), and age group (HR = 2.90, 95% CI: 1.12-7.49, p = 0.028), AJCC stage (HR = 4.56, 95% CI: 1.02-20.35, p = 0.046), and N stage (HR = 3.05, 95% CI: 1.07-8.74, p = 0.038) predicted overall survival (OS).Conclusions: T stage was identified as prognostic factor of RFS, and age, AJCC stage, and N stage were identified as prognostic factors of OS. Improving symptom awareness and earlier presentation among patients potentially at risk for anal SCC should be encouraged. Familiarity with the standard treatment among health care providers in China should be further improved. [ABSTRACT FROM AUTHOR]

Background: HIV testing plays a central role in the combat against HIV. We aimed to determine if the availability of HIV self-testing (HIVST) would increase the frequency of testing among men who have sex with men (MSM) attending university in China.Methods: A stepped wedge randomized controlled trial will be conducted in 4 provinces in China: Chongqing, Guangdong, Shandong, and Tianjin. Eligibility assessment will include (1) male, aged 16 years or older, (2) university student (technical diploma and undergraduate students), (3) MSM (sexual behaviors including mutual masturbation, oral sex, and anal sex), (4) HIV negative, and (5) willing to provide informed consent. Participants will be randomly allocated to HIV self-testing intervention with free HIVST kits in every 30 days according to the intervention waiting lists with a computer-generated randomized sequence. All participants will complete a self-administrated online questionnaire onsite at baseline and 12-month follow-up and complete an online questionnaire at 4- and 8-month. The primary outcome is the effect of HIVST on HIV testing frequency. Secondary outcomes include the change in sexual behaviors and HIV incidence.Discussion: No previous study had measured the effect of social media based HIVST intervention on the change in HIV testing behaviors, sexual behaviors and incident HIV infection among MSM attending university in China. Findings from this study will provide evidence for further interventional practice promotions and prevention strategies scale-up, including HIV testing, pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), and sexual partner serosorting.Trial Registration: Chinese Clinical Trial Registry: ChiCTR1900020645. Registered 11 January 2019. [ABSTRACT FROM AUTHOR]

Background This study was conducted to summarise the HIV epidemic, sexual behaviours and HIV testing among men who have sex with men (MSM) attending university in China.Methods: Five databases were searched for student MSM information in English and Chinese language publications. Meta-analyses were performed to calculate the pooled prevalence of HIV and syphilis, pooled mean age at first anal intercourse (AFAI) and the rate of other HIV-related behaviours among MSM attending university in China. Univariate meta-regression and subgroup analysis were conducted to explore potential sources of heterogeneity. Publication bias was measured using Egger's test.Results: Thirty-three articles representing 31 studies were included in the analysis. The pooled HIV prevalence was 4.1% (95% CI 3.1-5.0%). The estimated AFAI was 18.7 years, but 37.5% of students had their first anal intercourse before 18 years of age. Most (88.2%) had their first sexual intercourse with a male partner. Of the MSM attending university, 4.2% of MSM engaged in commercial sex (either selling or buying sex), 10.3% had ever engaged in group sex, 13.1% had had sex with a female partner in the past month and 10.1% had ever used drugs. Most (77.7%) sought sex partners via geosocial networking gay apps or the Internet, and 42.9% had ever tested for HIV. There was a tendency for an increase in lifetime HIV testing rate from 32% in 2005-07 to 53% in 2014-16.Conclusions: This review found high HIV prevalence, early AFAI and a high prevalence of sexual risk behaviours among MSM attending university in China. Interventions aimed at increasing HIV testing and reducing sexual risk behaviours are urgently needed among this young population. [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]

Background. The epidemiology of HPV in men who have sex with men (MSM) in Guangzhou, China, had not been reported previously. Methods. HIV-infected and HIV-uninfected MSM were recruited from a Guangzhou-based MSM clinic in 2013. Sociodemographic characteristics and sexual behaviors were collected. An anal cytological sample was taken for HPV testing. Results. We recruited 79 HIV-infected and 85 HIV-uninfected MSM. The median age was 26 years in both groups. The positivities of anal HPV of any type (81.0% versus 48.2%), any high risk type (50.6% versus 27.1%), any low risk type (55.7% versus 31.8%), and any 9-valent vaccine type (74.7% versus 36.5%) were all significantly higher among HIV-infected compared to that among HIV-negative MSM (p for all < 0.05). The great majority of HPV-infected MSM were infected with 9-valent vaccine types (59 out of 64 HIV-infected and 31 out of 41 HIV-uninfected). Anal bacterial infections were associated with higher anal HPV positivity and greater number of anal HPV types. Conclusion. Sexually active MSM in Guangzhou, especially those infected with HIV, had high and multiple HPV detections. The majority of these cases were potentially preventable by HPV vaccine. Regular anal exams and early HPV vaccination are warranted in this population. [ABSTRACT FROM AUTHOR]

Background. Our study aimed to assess the burden of depression and evaluate factors associated with depression and status of HIV risk behaviors among female sex workers (FSWs) in Guangdong, China. Method. We recruited FSWs from massage parlors, saunas, restaurants, hotels, hair salons, and streets in Guangdong, China, in 2014. Information on demographic characteristics, HIV testing history, and sexual behaviors was collected using a questionnaire. A blood sample was collected to test for HIV, syphilis, and HCV. A participant was defined as being depressed if she obtained 6 points or above using the 12-item General Health Questionnaire. Results. Among the 653 participants, 41.7% were 21–30 years old and 43.6% married. Overall, 52.4% were found to be depressed. FSWs who had correct syphilis related knowledge [aOR = 1.45; 95% CI: 1.04–2.03] and had primary sex partner (1.63, 1.14–2.33) were more likely to be depressed. FSWs who did not use a condom during their last sex with the primary sex partner were less likely to be depressed (0.47, 0.31–0.71). Conclusion. Our study observed high level of depression and HIV risk behaviors among Chinese FSWs. Future interventions should integrate mental health services in comprehensive interventions to prevent depression among Chinese FSWs. [ABSTRACT FROM AUTHOR]

Objective: To explore the feasibility of using Internet outreach to encourage men who have sex with men (MSM) to get tested for HIV at voluntary counseling and testing (VCT) clinics in Beijing and Urumqi, China. Methods: From June to August 2007, two volunteers contacted MSM using instant messaging, online chat rooms, mobile phone, and e-mail (active recruitment). Banners with study information were put at the front pages of three major Chinese gay websites (passive recruitment). Those contacted were offered a modest financial incentive to seek HIV testing at existing VCT clinics. Those who subsequently sought HIV testing services at VCT clinics and provided informed consent completed a questionnaire and a blood draw to test for HIV and syphilis. Results: A total of 3,332 MSM were contacted and 429 attended VCT clinics. One out of every 4 men that were recruited through instant messaging actually went for HIV testing, while the recruitment yields for online gay chat rooms, mobile phone contact, and email were 1∶6, 1∶10, and 1∶140, respectively. The majority of participants (80%, 317/399) reported being motivated to seek HIV testing out of concern for their health, and only 3% (11/399) reported being motivated by the financial incentive. Active recruitment tend to recruit MSM who are younger (X2 = 11.400, P = 0.001), never tested for HIV (X2 = 4.281, P = 0.039), tested less often (X2 = 5.638, P = 0.018). Conclusion: Internet outreach is a promising way to encourage MSM to seek HIV testing at existing VCT clinics. Active recruitment can target MSM who are younger, never tested for HIV and tested less often. [ABSTRACT FROM AUTHOR]

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HIV-positive men who have sex with men (MSM) are at high risk of suicide and experience intersectional inequalities. The Social Determinants of Health (SDH) framework provides valuable insights into how inequalities can lead to adverse outcomes. This study aimed to employ the SDH framework to identify factors that contribute to suicidal behaviors among this population. 1410 HIV-positive MSM were recruited using a web-based questionnaire, whose mean age was 30.77 ± 6.92 years old. Participants completed questionnaires including baseline information and psychological measurements, such as Suicidal Behaviors Questionnaire-Revised (SBQ-R). Logistic regression analysis was conducted to screen for risk factors associated with suicidal behaviors. More than half of the participants (53.3 %, 752/1410) had an SBQ score of 7 or higher. Binary logistic regression analysis of structural and intermediary determinants (Model 3) revealed that sexual orientation, stigma (ORs: 1.018, 95 % CI: 1.005–1.032), interpersonal needs (ORs: 1.021, 95 % CI: 1.010–1.031), depression (ORs: 1.037, 95 % CI: 1.001–1.074) and entrapment (ORs: 1.018, 95 % CI: 1.004–1.032) were positively correlated with suicidal behaviors. Individuals with other or unknown sexual orientation had significantly higher rates of suicidal behaviors compared to those with a heterosexual sexual orientation (ORs: 5.021, 95 % CI: 1.529–17.640). Sampling of HIV-positive MSM posed challenges in data collection. It may introduce selection bias and affect generalizability. This study identified that sexual orientation, stigma, interpersonal needs, depression, and entrapment were significantly associated with suicidal behaviors among HIV-positive MSM. Additionally, these factors can be social determinants of health that contribute to suicidal behaviors. • This study is the first to apply the SDH framework in HIV-positive MSM. • SBQ scale rather than one or a few questions was used to measure the suicidal behaviors among HIV-positive MSM. • Sexual orientation, stigma, interpersonal needs, depression, entrapment contribute to suicidal behaviors in HIV-positive MSM. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) attending university are a high-risk population for human papillomavirus (HPV) infection and are a neglected population of HPV vaccination programs in China. To provide evidence for HPV vaccination policies, we conducted this study to examine the prevalence and factors associated with anal HPV infection among MSM attending university in China. A self-administered online questionnaire was conducted to collect information on social demographics and sexual behaviors. A self-collected rectal swab specimen was collected to test for 37 HPV types. A total of 426 participants were tested for HPV. The median age was 20 years. HPV prevalence was 37.5% for any type, 29.8% for nine-valent vaccine types, 24.6% for four-valent vaccine types, 11.5% for HPV-16/18, and 15.7% for HPV-6/11. Men enrolled in a technical diploma, living in Northern China, having more than two sex partners, being bottom or versatile in anal sex, and having a human immunodeficiency virus (HIV) testing history were more likely to have positive anal HPV of any type. Our study found a high prevalence of anal HPV infection among MSM attending university in China, with HPV vaccine-preventable types being the most popular types in this group. Thus, our findings highlight the urgency of promoting HPV vaccination among teenage MSM. [ABSTRACT FROM AUTHOR]

Background: HIV prevalence among men who have sex with men (MSM) in China is rising rapidly, and unprotected anal intercourse (UAI) is associated with HIV transmission. Recent research has shown that associations between UAI and other factors can differ according to the type of sex partners, including regular partners and casual partners. This study aimed to explore the relationship between sexual compulsivity and UAI according to partner type among MSM in Shanghai, China.Methods: A cross-sectional study was conducted among 547 MSM from four districts in Shanghai, China. All participants were recruited using snowball sampling. The Sexual Compulsivity Scale was used to evaluate participants' sexual compulsivity. Multivariable logistic regression was used to identify factors associated with sexual compulsivity and UAI. The mediation effects of substance use before sex on the relationship between sexual compulsivity and UAI were tested through mediation analyses.Results: After adjusting for sociodemographic variables, sexual compulsivity was associated with overall UAI (adjusted odds ratios [AOR] = 1.039, 95% confidence intervals [CI] = 1.004-1.075), UAI with non-regular sex partners (AOR = 1.089, 95% CI = 1.033-1.148) and UAI with commercial sex partners (AOR = 1.185, 95% CI = 1.042-1.349). No significant association was found between sexual compulsivity and UAI with regular sex partners (AOR = 1.029, 95% CI = 0.984-1.077). Mediation analyses indicated that the relationship between sexual compulsivity and UAI was not mediated by either alcohol use before sex or drug use before sex.Conclusions: The association between sexual compulsivity and UAI varies depending on the type of UAI partner. Therefore, individuals may engage in different types of UAI for different reasons, and tailored HIV cognitive-behavioral intervention programs are needed. [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]

• 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]

Men who have sex with men (MSM), especially those infected with human immunodeficiency virus (HIV), are at disproportionate risk for human papillomavirus (HPV) infection. Data about anal HPV prevalence among MSM in southern China are limited. MSM were recruited between January 1 and August 31, 2017 in three metropolitan cities: Guangzhou, Shenzhen and Wuxi. A self-completed tablet-based questionnaire was used to collect information about socio-demographic/sexual behavioral characteristics, history of sexually transmitted infections (STIs) and recreational drug use. An anal brush was used to collect exfoliated cells for HPV DNA testing and genotyping, and a blood sample was taken for HIV testing. Penile/anal warts were checked by a clinician. A total of 536 MSM were enrolled, including 39 HIV-positive and 497 HIV-negative individuals. Compared with HIV-negative MSM, prevalence of any HPV genotype (79.5% vs 46.7%), any high-risk genotype (64.1% vs 36.6%) and any nonavalent vaccine-preventable genotype (53.9% vs 31.6%) was significantly higher in HIV-positive MSM, with all P < 0.01. HIV infection (adjusted odds ratio [AOR], 4.28; 95% confidence interval [CI], 1.87–9.80), using recreational drugs (AOR, 1.87; 95% CI, 1.22–2.87), having ≥ 3 years of sexual experience (AOR, 1.52; 95% CI, 1.01–2.28), having ≥ 6 lifetime male partners (AOR, 1.92; 95% CI, 1.29–2.86), and engaging receptive anal intercourse (AOR, 2.30; 95% CI, 1.48–3.57) were associated with higher anal HPV prevalence. Any HPV prevalence increased with age, from 24.5% at < 20 years to 55.8% at ≥ 40 years. Anal HPV prevalence was high among MSM in southern China, significantly associated with HIV status and sexual experience. HPV prevalence increased with age among MSM. A targeted HPV vaccination program for teenage MSM might be necessary. Our findings will inform targeted HPV modelling among MSM in China. [ABSTRACT FROM AUTHOR]

Objective To determine the level of awareness on human papillomavirus (HPV) vaccine and acceptance of HPV vaccination among parents of junior middle school students. Methods A cross sectional survey employing cluster sampling was conducted in Jinan, Shandong Province of China in January of 2013. Results A total of 400 parents of junior middle school students participated in the questionnaire survey, among whom 360 (90%) completed valid questionnaires. About 88 (22.63%) parents had ever heard of HPV. Only one in ten (10.2%) knew about HPV vaccine. Parents willing to accept HPV vaccination for children accounted for 40.8%. Factors associated willing to accept HPV vaccination for children among parents were: female parent (AOR: 0.38, 95%CI: 0.21–0.67), having ever heard of HPV vaccine (AOR: 2.38, 95%CI: 1.01–5.61), thinking HPV vaccination should commence before sexual debut(AOR: 2.16, 95%CI: 1.21–3.85), thinking HPV vaccination should commence before 12 years old (AOR: 2.76, 95%CI: 1.02–7.46) or 13–15 years old (AOR: 4.75, 95%CI: 1.79–12.61), concern about suffering from cervical cancer and/or genital warts (AOR: 2.43, 95%CI: 1.31–4.50). About 60% of parents were in favor of future HPV vaccination promoting in China believing that HPV vaccine could efficiently prevent cervical cancer, anal cancer or genital warts, 37.4% of parents with expectation of governmental subsidy and price regulation. Conclusion Parental awareness level of HPV vaccine and willingness to accept HPV vaccination for children was low. However, the general attitude of many participants toward future promoting of HPV vaccination in China was encouraging, particularly if certain expectations were met. [ABSTRACT FROM AUTHOR]