BACKGROUND:Social and sexual networks, particularly the spaces where men who have sex with men (MSM) meet and interact, play a crucial role in shaping HIV risk and prevention behaviors. However, few studies have leveraged venue-level data to optimize the reach of targeted interventions in China. METHODS:We conducted a venue-based social network analysis among 301 MSM recruited via online platforms and time-location sampling in a major metropolitan area. Participants identified social spaces they frequented, including both physical venues and digital platforms. We characterized these spaces based on HIV risk behaviors, STI prevalence, and PrEP-related indicators, and applied centrality and KeyPlayer analyses to identify high-impact spaces for intervention reach. RESULTS:MSM reported visiting an average of 2.9 spaces, with high prevalence of condomless anal sex (81.7%) and hazardous drinking (42.2%). We identified 23 key venues, including six newly nominated by participants. Blued and WeChat emerged as the most influential spaces, collectively connecting 91.4% of MSM and 100% of other social spaces. Risk levels varied widely across venues, with certain spaces exhibiting elevated rates of HIV and syphilis. Importantly, participants reached through key venues showed significantly higher PrEP awareness and willingness. CONCLUSION:Strategic engagement of high-centrality venues, especially popular virtual platforms, can substantially enhance the coverage and equity of HIV prevention efforts among MSM. Venue-level network analysis is a valuable tool to prioritize and tailor public health interventions.

Introduction:In order to enhance the effectiveness of resource allocation, regions must tailor their responses to their specific epidemiological and economic situations.Methods:Utilizing Spectrum software, we projected the cost-effectiveness of 10 chosen HIV interventions in six cities in eastern China from 2019 to 2028. We assessed three scenarios - Base, Achievable, and Idealized - for each city. The analysis included the projected number of HIV infections and deaths averted, as well as the incremental cost-effectiveness ratios for each intervention in the six cities.Results:In Shijiazhuang, Wuxi, Yantai, and Zhenjiang, cities with initially low antiretroviral therapy (ART) coverage, ART showed significant effectiveness, especially for males. Conversely, in Foshan and Ningbo, where ART coverage was notably high, oral pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) proved effective in the Idealized scenario. MSM outreach, ART for males, and ART for females demonstrated cost-effectiveness across all six cities in both Achievable and Idealized scenarios at the predefined thresholds for each city.Discussion:Maintaining an appropriate coverage rate for outreach to MSM can lead to cost-effectiveness. In cities with low ART coverage, scaling up ART remains a crucial intervention. In regions with high ART coverage, consideration may be given to the utilization of oral PrEP for MSM individuals, requiring budget allocation.

ABSTRACT Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach that significantly reduces HIV acquisition. Our study aimed to explore factors associated with PrEP willingness and intention to adhere to PrEP among MSM through a cross-sectional survey in Nanjing, Jiangsu province, China. Location sampling (TLS) and online recruitment were used to recruit participants to gauge their PrEP willingness and intention to adhere. Of 309 HIV-negative/unknown serostatus MSM, 75.7% were willing to use PrEP and 55.3% had high intention to take PrEP daily. Willingness to use PrEP was positively associated with having a college degree or higher (AOR = 1.90, 95%CI: 1.11–3.26) and higher anticipated HIV stigma (AOR = 2.74, 95%CI: 1.13–6.61). Facilitators of intention to adhere included higher education levels (AOR = 2.12, 95%CI: 1.33–3.39) and higher anticipated HIV stigma (AOR = 3.65, 95%CI: 1.36–9.80), whereas a primary barrier was community homophobia (AOR = 0.43, 95%CI: 0.20–0.92). This study documented high willingness to use PrEP, yet lower intention to adhere to PrEP in a sample of MSM in China. Public interventions and programs to promote adherence of PrEP for MSM is urgently needed in China. Psychosocial factors should be addressed and taken into consideration for PrEP implementation and adherence programs.

Introduction:In order to facilitate human immunodeficiency virus (HIV) treatment and prevention, the resource needs for HIV national strategic planning in developing regions were estimated based on Spectrum, the universal HIV cost-effectiveness analysis software.Methods:Based on the theoretical framework of Spectrum, the study developed a cost measurement tool for HIV, and calculated the cost of HIV prevention and control in 6 sampled cities in China during 2015-2019 using the Spectrum model.Results:From 2015 to 2019, the average annual costs for HIV prevention and control for Shijiazhuang, Yantai, Ningbo, Zhenjiang, Foshan, and Wuxi cities were 46.78, 47.55, 137.49, 24.73, 74.37, and 58.30 million Chinese yuan (CNY), respectively. The per capita costs were 4.37, 6.73, 17.33, 7.77, 17.56, and 8.91 CNY, respectively. In terms of the cost structure, the ratio of preventive intervention funds to therapeutic intervention funds (antiviral treatment) varied in sampled cities.Discussion:Developing comprehensive and systematic HIV fund calculation methods can provide a research basis for rational resource allocation in the field of HIV.

1991年,江苏省发现首例艾滋病病毒感染者,30年来,在江苏省委省政府的重视和领导下,在江苏省卫健委及多部门合作支持和全社会广泛参与下,艾滋病防治工作在宣传教育、疫情监测预警、实验室检测、治疗关怀、科学研究和社会组织参与等领域取得了重要进展,各项防治目标全面完成,为江苏省艾滋病防治"十四五"规划开好局、起好步奠定了坚实的基础.本文总结了 30年来江苏省艾滋病防治工作主要进展.

Many countries worldwide have implemented dedicated measures, such as shelter at home, to contain the spread of the COVID-19 virus. However, those mitigation measures may have major implications for individuals living with someone abusive or controlling. Domestic violence (DV) may be one of the unintended consequences of public health measures due to increased various stressors and reduced access to support and services. There has been a lack of empirical research on DV victimization among gender and sexual minorities, a population vulnerable to interpersonal violence and its associated adverse health outcomes. This study investigates the prevalence of DV victimization among men who have sex with men (MSM) in Jiangsu Province, China, during the COVID-19 lockdown and its correlates with COVID-19–related psychosocial and health stressors. A total of 413 MSM were recruited via snowball sampling, venue-based, and internet-based sampling from four cities in Jiangsu Province. After providing informed consent, all participants completed study questionnaires, followed by HIV testing. Over a quarter of the participants (27.4%) reported DV victimization during the COVID-19 lockdown, including experience of verbal, physical, or sexual abuse. After adjusting sociodemographic factors, DV victimization was associated with various adverse experiences during the COVID-19 lockdown, including increased stress or anxiety level, increased alcohol use, and housing instability. Study findings underscore the prevalence of DV victimization among MSM during the COVID-19 pandemic in China. The results can inform public health efforts to raise awareness and address DV victimization among MSM in the low- and middle-income country context during the COVID-19 pandemic. Adequate health and social services and economic resources are also critical to address the needs of MSM experiencing DV victimization.

Objectives Some of community mitigation efforts on COVID-19 created challenges to ongoing public health programs, including HIV care and prevention services among men who have sex with men (MSM). The goal of the current study was to explore sociodemographic factors and the impact of COVID-19 on HIV testing among Chinese MSM during state-enforced quarantine. Methods We conducted a community based survey between May 1st to June 30th, 2020 on COVID-19 related impacts on HIV testing among 436 China MSM during the COVID-19 state-enforced quarantine. Results One-third (33.7%) of MSM received HIV testing during the quarantine period. Few participants reported difficulty accessing facility-based testing (n = 13, 3.0%) or obtaining HIV self-test kit online (n = 22, 5.0%). However, 12.1% of participants reported being afraid of getting facility-based HIV test due to concerns about the risk of COVID-19. In the multivariate logistic regression model, participants who were married (aOR: 1.89, 95%CI: 1.19-3.01), reported increased quality of sleep (aOR: 2.07, 95%CI: 1.11-3.86), and increased difficulty in accessing health care (aOR: 2.34, 95%CI: 1.37-3.99) were more likely to get an HIV test during the state-enforced quarantine. Conclusion The mitigation measures of COVID-19 have created various barriers to access HIV related prevention services in China, including HIV testing. To mitigate these impacts on HIV prevention and care services, future programs need to address barriers to HIV-related services, such as providing high-quality HIV self-testing. Meanwhile, psychological services or other social services are needed to those experiencing mental distress.

目的:通过结构方程模型对男男性行为(men who have sex with men,MSM)人群心理量表数据进行分析,探索该人群心理相关因素对HIV暴露前预防(pre-exposure prophylaxis,PrEP)使用意愿和药物依从性影响,为我国有效实施MSM人群PrEP干预策略提供依据.方法:采用网络平台招募和时间场所抽样方法在南京市招募MSM人群,利用问卷星软件进行问卷调查.采用结构方程模型对MSM人群HIV预期耻辱感、社会性向歧视和抑郁症状3个心理量表数据进行分析,探索其与PrEP使用意愿和药物依从性之间的作用机制.结果:75.73％的调查对象愿意使用PrEP;55.34％自报能保持高药物依从性.调查对象HIV预期耻辱感和社会性向歧视得分较高,中位数分别为20(17～23)和27(22～30),抑郁症状得分较低,中位数为1(0～2).HIV预期耻辱感对PrEP使用意愿与药物依从性存在直接正向作用,效应值分别为0.13(P＜0.05)和0.14(P＜0.05).社会性向歧视负向预测药物依从性(β=-0.15,P＜0.05);抑郁症状在社会性向歧视与药物依从性之间起部分中介作用,效应值为0.03(P＜0.01).结论:MSM人群PrEP使用意愿度较高,但药物依从性较低.心理因素对MSM人群的PrEP使用意愿和药物依从性影响显著,应将心理卫生服务与PrEP防治策略结合起来,更好发挥PrEP预防干预效果.

Background Recreational drug use is popular among men who have sex with men (MSM), while there is limited information about polydrug use and its consequent impact on sexual health and human immunodeficiency virus (HIV) acquisition. Methods MSM were recruited from a multicenter cross-sectional survey conducted in seven Chinese cities. Participants were divided into four subgroups based on the number of recreational drugs (RDs) used in the past 6 months. “Polydrug use” was defined as simultaneous use of ≥2 types of RDs. Information on demographics and HIV high-risk behaviors (HIV-HRBs) was collected, and blood samples were tested for recent HIV infection by the BED capture enzyme immunoassay. Results A total of 4,496 Chinese MSM participated, of which 28.4% used RDs, and 5% were polydrug users. Polydrug users commonly took poppers with one or more types of other RDs (e.g. methamphetamine). Polydrug users were likely to be aged 26–30 years, have low educational attainment, be internal migrants, have a high monthly income, use versatile positions during anal intercourse, and have inadequate knowledge about prevention of HIV infection (P<0.05 for all). As the number of RDs used in the past 6 months increased, the prevalence of HIV-HRBs increased (P<0.05 for all). The odds of recent HIV infection were higher among those who used one type (aOR = 2.2, 95%CI: 1.5–3.0) or two types of RDs (2.3, 1.0–5.2) in the past 6 months compared with those who did not use RDs. The population-attributable fractions of most HIV-HRBs for recent HIV infection were higher among polydrug users compared with those who used only one type of RD or used no RD in the past 6 months. Conclusion The level and pattern of polydrug use among Chinese MSM were different from developed countries. Polydrug use had a dose-effect relationship with HIV-HRBs. Polydrug users who have greater levels of RDs use are more likely to engage in various sexual risks, thus may associated with new HIV infections.

目的 了解江苏省社会组织参与国家艾滋病防治基金(China AIDS fund for non-governmental organ-izations,CAFNGO)项目整体情况,促进其更积极主动参与艾滋病防治工作.方法 读取CAFNGO项目管理信息系统2016-2020年社会组织每季度填报的数据,对资料进行整理和分析.结果 2016-2020年,江苏省有11个设区市的社会组织参与139个项目,其中女性商业性工作者(female sex workers,FSW)干预类项目25个(17.98％),男男同性性行为人群(men who have sex with men,MSM)干预项目59个(42.45％),吸毒者干预项目4个(2.88％),HIV感染者和患者(people living with HIV,PLWH)随访管理和关怀救助类项目51个(36.69％).MSM HIV抗体阳性率由2016年4.52％下降至2020年3.13％,累计HIV抗体阳性1748例,阳性率3.81％.2017-2020年,成功转介抗病毒治疗人数占HIV抗体阳性数的83.82％(1145/1366).对8964例PLWH开展了随访管理和关怀救助,8868例(98.93％)符合抗病毒治疗条件,其中接受抗病毒治疗8732例(98.47％),完成病毒载量检测6553例,病例病毒载量检测＜1000拷贝/ml 6376例(97.30％).结论 CAFNGO支持江苏省社会组织工作成为艾滋病防治领域的重要内容,应发挥社会组织工作的自主性与积极性,进一步预防艾滋病传播.

Background: Despite strengthened efforts on human immunodeficiency virus (HIV) prevention and control, new HIV infections continue to increase among men who have sex with men (MSM) in China. Pre-exposure prophylaxis (PrEP), a highly effective HIV-prevention tool, has recently been included in China's Action Plan of HIV Prevention and Control. To promote future PrEP implementation, this study aims to identify the barriers and facilitators in PrEP use intention among MSM in China.Methods: In 2018, a cross-sectional survey was conducted among 300 MSM in Nanjing, Jiangsu Province. Questions on demographics, sexual behavior (including a seven-item high-risk behavior index), PrEP use intention, PrEP-related awareness and accessibility, and a seven-item public HIV stigma scale were included in the questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP use intention. Results: Overall, 44.67％ of the participants had more than two male sexual partners and 5.56％ had HIV-positive sexual partners. Only 57.00％ had heard of PrEP and only four (1.33％) participants had used PrEP. However, 75.34％ expressed the willingness to use oral PrEP if its efficacy was assured. The beliefs that "PrEP can prevent HIV if taken as prescribed" (adjusted odds ratio (AOR) = 4.84, P < 0.001) and "PrEP can be scaled up in the community" (AOR = 3.24, P < 0.001) were positively associated with oral PrEP use intention. Concerns of side effects were negatively associated with oral PrEP use intention (AOR = 0.32, P = 0.006). Further, 77.00％ of the participants would choose injectable or implanted PrEP instead of oral PrEP. One of the PrEP stigma items, "Not certain if doctors can prescribe PrEP if I go to the clinic" was positively associated with the intention to use injectable or implanted PrEP (AOR = 3.03). The items "Heard of PrEP" (AOR = 2.74) and "PrEP can prevent HIV if taken as prescribed" (AOR = 2.65) were also positively related to the intention to use injectable or implanted PrEP. The most common concerns regarding PrEP use were efficacy (44.67％) and side effects (38.67％). The most common reasons for using injectable and implanted PrEP were adherence (81.94％ and 77.86％, respectively) and privacy concerns (56.48％ and 55.00％, respectively). Affordable price and coverage by health insurance were the driving factors for PrEP use. Conclusion: Given the low level of awareness of PrEP-related information in China, it's necessary to provide interventions for high-risk individuals and communities, in order to increase their awareness and knowledge of PrEP. Furthermore, additional alternatives to HIV prevention, such as long-acting injectable or implanted PrEP, should be investigated to reduce the risk of HIV infection in at-risk MSM. Even if this programme could be approved by the National Medical Products Administration of China and implemented, a supportive social environment for MSM is essential during its implementing.

Objectives: To measure prevalence and risk factors of poor mental health, suicidal ideation, and suicide attempt among transgender women in Jiangsu province, China. Methods: We surveyed 250 transgender women with mean age of 27.9 years from July 2018 to May 2019 in Jiangsu province, China. Logistic regression analysis characterized risk factors for mental health, suicidal ideation, and suicide attempt. Results: Many transgender women experienced discrimination, including verbal abuse (56.0%), physical abuse (32.0%), and sexual violence (32.0%) during their lifetime. Classification by the Kessler Psychological Distress Scale found 32.4%% to be in good mental health, while 24.0%, 16.8%, and 26.8% had mild, moderate, and severe psychological distress respectively. In multivariable logistic regression, severe psychological distress was correlated with bisexual orientation (vs. gay/lesbian, aOR = 2.9, 95%CI = 1.5-5.8), being unsure of sexual orientation (vs. gay/lesbian, aOR = 4.7, 95%CI = 1.8-12.8), experience of verbal abuse (aOR = 1.8, 95%CI = 1.1-3.1), and less severe with alcohol use (aOR = 0.6, 95%CI = 0.3-0.9) (P< 0.05). Many transgender women also reported suicidal ideation (22.0%) and prior suicide attempt (25.6%). Compared to no suicidal ideation, moderate (aOR = 4.9, 95%CI = 1.6-15.2) or severe psychological distress (aOR = 38.6) were asso-ciated with prior suicide attempt (P< 0.05). Residing in Jiangsu province (vs. not residing in Jiangsu, aOR = 0.3, 95%CI = 0.1-0.6) and higher income (vs. lower income, aOR = 0.6, 95%CI = 0.4-0.9) were protective factors for suicide attempt (P< 0.05). Conclusion: Chinese transgender women experience high levels of discrimination, abuse, poor mental health, suicidal ideation, and suicide attempts in Jiangsu province. Society-wide interventions need to be developed to mitigate transphobic discrimination among transgender women in China.

目的 了解江苏省跨性别女性人群(MTF)危险行为特征、艾滋病病毒(HIV)检测率及其影响因素,为相关干预的实施提供依据.方法 采用同伴推动抽样法(RDS)在江苏省内招募MTF,用匿名自填问卷收集社会人口学、行为学以及心理健康等方面信息,并采集指尖血进行HIV和梅毒快速检测.结果 共招募符合条件MTF250人,44.00％年龄分布在18～24岁,高中及以下学历占36.80％;47.60％报告服用过激素,18.00％接受过性别重塑手术,34.40％曾被诊断患有抑郁症;调查对象20.80％自述曾从事过性工作;过去一年在与他人发生性行为时或性行为之前饮酒率和毒品使用率分别为37.60％和4.00％;最近6个月多性伴数(≥2个)占35.60％,性行为中无保护性肛交和阴道交发生率为25.60％和5.20％;调查样本HIV感染者占比为14.80％;去除一年前已知HIV阳性者,最近一年HIV检测率为51.72％(120/232),检测阳性者37例,均确诊为阳性.多因素分析显示,从事过性工作[调整比值比(AOR)=2.36,95％可信区间(CI):1.02～5.46]、未服用激素(AOR=2.34,95％ CI:1.24～4.41)、未患有抑郁症(AOR=2.10,95％ CI:1.11～4.02)是促进MTF最近一年接受HIV检测的影响因素.结论 首次在江苏省开展针对MTF人群的调查,显示跨性别女性人群具有感染HIV高风险但较低HIV检测率特征,亟需采取有效干预措施控制艾滋病在该人群中的流行.

China's national guidelines call for increasing HIV pre-exposure prophylaxis (PrEP) use to reverse the epidemic in populations at highest risk. However, few data exist on PrEP awareness and willingness among trans women in China. Our research aim was to fill this data gap through a cross-sectional survey among trans women in Nanjing and Suzhou cities of Jiangsu province. Respondent-driven sampling (RDS) was used to recruit participants to gauge their awareness of and willingness to use PrEP. Logistic regression analysis was used to characterize associations with awareness of PrEP and willingness to use PrEP. Of 222 HIV-negative/unknown serostatus trans women, 33.3% were aware of PrEP and 49.1% were willing to use PrEP. PrEP awareness was associated with a university degree or above (adjusted odds ratio [AOR] 2.77, 95% CI 1.31-5.89) and not using alcohol with sex (AOR 2.02, 95% CI 1.00-4.09). Willingness to use PrEP was higher among trans women with one (AOR 3.56, 95% CI 1.68-7.54) or multiple sexual partners (AOR 2.53, 95% CI 1.24-5.15) compared to those with no partners. This study witnessed low awareness of PrEP, yet substantial willingness to use PrEP. Implementation research to identify ways to promote, scale up access, and assess effectiveness of PrEP for trans women is urgently needed in China.

BACKGROUND:The World Health Organization has recommended HIV self-testing (HIVST) as an alternative testing strategy given the limitations of facility-based testing. While the benefits of HIV self-testing have been demonstrated at the individual level among men who have sex with men (MSM), limited data exist on if this testing approach can be effectively diffused through individuals' social or sexual networks. The objectives of this study were to examine patterns and correlates of HIVST distribution within Chinese MSM's sexual networks.METHODS:Data used for this analysis was a part of the process evaluation of an HIVST intervention trial among MSM in Nanjing, China. Between May and October 2017, we enrolled 400 men into the trial. Participants assigned to the intervention group (N = 200) were given three HIVST kits at baseline and could request more during the follow-up periods. We incorporated measures for process evaluation in the self-administered online follow-up surveys. This analysis reported findings from the three-month follow-up survey in the intervention group. Frequencies and percentages were used to describe characteristics of participants who distributed kits to their sexual partners as well as patterns of distribution. Multivariable logistic regression was conducted to identify independent correlates of participants who distributed the kits.RESULTS:Of the 177 participants retained (88.5%) at the three-month follow-up, 72 (40.7%) distributed one or more kits to either primary or casual partners. About half of distributors (51.4%) gave one HIVST kit to their sexual partners while 15.3% distributed 3 or more. Over half gave these kits (58.3%) to primary sexual partners while 27.8% reported giving the kits to both primary and casual partners. About half (54.2%) of distributors used the kits together with their partners. Compared to participants who had an HIV test in the past six months, those who tested over six months ago or never tested had significantly lower odds of distributing the kits (AOR = 0.484, 95% CI: 0.250-0.983, p = 0.032). Compared to those who had not used the kits themselves, participants who did had significantly higher odds of distributing the kits (AOR = 3.345, 95% CI: 1.488-7.517, p = 0.003). Participants who reported higher HIV testing efficacy had 2.051 fold greater odds (95% CI: 1.062-3.961, p = 0.033) of distributing the kits compared to those who had lower efficacy.CONCLUSION:Our study demonstrated that a sexual network-based approach to distributing HIVST among Chinese MSM is feasible and can be a promising strategy to improve the effectiveness of HIVST programs including its reach to untested men. Such approach should be complimented by intervention components that enhance HIV testing efficacy and improve experiences of HIVST.

To the Editors: The past decade has seen progress toward getting to zero HIV infections in San Francisco overall. New HIV diagnoses dropped from 521 in 2008 to 197 in 2018, a 62% decrease.1 HIV incidence estimated by a CD4 model2 corroborates a parallel, commensurate drop in incident infections, from a projected 330 in 2013 to 190 in 2017.1 Unfortunately, there is insufficient sample size to estimate HIV incidence separately for smaller populations who may have elevated risk. Directly measured rates of HIV seroconversion observed in longitudinal studies are logistically difficult and costly and therefore rare.3 Limitations of sample size and resources are substantial for estimating or measuring HIV incidence among transgender women (hereafter "trans women"), the population with the highest burden of HIV in San Francisco1,4 and in many parts of the world.5 We report results from the TransNational Study in San Francisco, the primary aims of which are to measure the rate of HIV seroconversion and identify predictors of HIV acquisition among trans women. The present analysis focuses on identifying demographic disparities in HIV risk, particularly testing hypotheses on whether HIV incidence is higher among trans women who are young, members of racial/ethnic minority groups, living in poverty, and homeless based on differences in HIV prevalence and recent trends in new diagnoses in San Francisco.1 Trans women were defined by being assigned male sex at birth and currently identify as other than male gender. Trans women were enrolled into the cohort using a long-chain peer-referral method previously used to accrue a cohort of young trans women in San Francisco6 and men who have sex with men (MSM) in Nanjing, China.7 In brief, initial seeds were identified from diverse social networks and instructed to refer other eligible trans women to the study. Participants were interviewed face-to-face on demographics and risk behaviors and tested for HIV. Trans women who tested negative for HIV and were 18 years or older were eligible. Participants were retested and interviewed at 6, 12, and 18 months. Participants who seroconverted were linked to HIV care. We used an incidence density approach (ie, the number of events divided by the person-time of follow-up) to calculate rates of HIV seroconversion. Incidence rate ratios were used to compare differences in rates among subgroups of trans women assuming a Poisson distribution. When a subgroup had zero seroconversions, we calculated 97.5% one-sided confidence intervals (CI) and compared groups using the Z-test. Referrals to HIV prevention programs, including pre-exposure prophylaxis (PrEP), were offered at each visit. Participants were given $55 for completion of the survey and HIV testing at their initial visit, increasing to $70 for the 18-month visit. Participants were given $20 for each eligible referral to the study. The protocol was approved by the Human Research Protection Program of the University of California San Francisco. Participants provided written informed consent. Of 415 who were HIV negative at enrollment and agreed to follow-up, 377 were seen at their 18-month visit and 8 seroconverted by the time of their 18-month visit (92.6% retention). The 8 seroconversions occurred over 604 person-years (py) of follow-up for an incidence rate of 1.3 per 100 py (95% CI: 0.7 to 2.7) (Table 1).TABLE 1.: HIV Incidence Among Trans Women in a Longitudinal Cohort, San Francisco, 2017–2019Several disparities in HIV incidence rates were noted. Trans women aged 18–24 years had a significantly higher HIV incidence (3.7 per 100 py; 95% CI: 1.2 to 11.6) compared with those aged 25 years and older (1.0 per 100 py; 95% CI: 0.4 to 2.3, P = 0.04). Age categories above 25 years were collapsed because they were similar in magnitude. HIV incidence was significantly higher among Latina/x trans women (2.6 per 100 py; 95% CI: 1.1 to 6.1, P = 0.03) and trans women of color (2.2 per 100 py; 95% CI: 1.1 to 4.3, P = 0.01) compared with white trans women. Trans women who had been incarcerated (2.3 per 100 py; 95% CI: 1.1 to 4.8, P = 0.04) and those without health insurance (5.8 per 100 py; 95% CI: 1.5 to 23.2, P = 0.02) also had significantly elevated HIV incidence. Incidence estimates among trans women for comparison are rare. Twenty years ago, HIV incidence was calculated among trans women in San Francisco in a retrospective cohort, arriving at a rate of 7.8 per 100 py (95% CI: 4.6 to 12.3).8 The estimate suggests a substantial decline to the current level. Serial cross-sectional surveys of trans women in San Francisco show HIV infection sustained at high levels over the past several years.4 We recognize the risk in overinterpreting data based on 8 seroconversions. Small numbers may miss true associations in the population. We also acknowledge potential Hawthorne effects. Multiple risk assessments, HIV testing, and referral to prevention programs, such as PrEP, are likely to dampen HIV incidence, underestimating true rates in the population. Other studies note challenges in measuring HIV incidence among trans women. The iPrEx trial of PrEP efficacy was able to enroll 339 trans women among 2499 total participants across 11 sites.9 The researchers cite difficulties in identifying trans women and determining the preventive effects of PrEP specifically for them. Other studies combine MSM with trans women without being able to separate them for analysis.5 For example, a recent analysis of HIV incidence among key populations in Bangkok across 10 years was unable to distinguish between MSM and trans women.10 We concur with these researchers in the strong need for trans-specific longitudinal studies, including benchmark measures of HIV incidence and randomized controlled trials with incident endpoints. On the other hand, the fact that we were able to find significantly elevated HIV incidence for some groups speaks to the potential magnitude of these effects. Significant correlates of HIV incidence found in our cohort echo concerns emerging from citywide surveillance data.1 Despite decreases overall, new HIV diagnoses have increased for black/African Americans and Latina/x people. Prior studies also found significantly higher incidence and prevalence of HIV among trans women of color.4,8 History of incarceration and lack of health insurance point to structural drivers of continued HIV acquisition among trans women that must be addressed. Structural risks of housing instability, low income, and education are risk factors for sex work and incarceration and are more prevalent among trans women of color.11–13 Instability may also preclude trans women from completing the steps required to enroll in health insurance and establish care in the public health system where biomedical HIV prevention is available. Structural factors disproportionately affecting trans women of color are also tied to poor HIV care outcomes and suboptimal access to HIV prevention use.14,15 Such risks are exacerbated in our city, which has wide disparities in wealth, housing, and employment opportunities.16 Perhaps, the most disheartening finding is the elevated HIV incidence among young trans women. The nearly four-fold higher incidence among transgender youth predicts a continuing high burden of infection for years to come. In an era of intensifying efforts to get to zero HIV infections by 2030,17 any incidence rate above 1 per 100 py is a worrisome reminder that the endgame of eliminating new HIV infections may see diminishing returns as the remaining cases occur among our most marginalized communities.

Objective:This study aimed to study the factors influencing the human immunodeficiency virus (HIV) couple testing among men who have sex with men (MSM), to provide the basis for formulating HIV couple testing strategies for MSM population.Method:①A 1:2 matching analysis was conducted among MSM who did couple testing identified at the survey on AIDS prevention and intervention in Nanjing from May to October in 2017, and the control group was among the people who did not do the couple testing in the same survey of the same period of time. Each case was matched by age (±5), sexual orientation and marital status. ②The questionnaire design was based on the information of demography and behavioristics, using network survey. ③The data was screened by Excel first, then the logistic regression model is used for univariate and multivariate analysis. Results:A total of 73 patients were tested for sexual partners, while 146 subjects were matched in the control group. Univariate analysis showed that the number of previous HIV tests (χ2=6.195, P＜0.05), the number of previous HIV self-testing (χ2=33.658, P＜0.05) and the sex role of"0" (χ2=5.223, P＜0.05) had statistical significance with the sexual partner test. Multivariate analysis showed that the number of HIV self-testing in the past (OR=8.502, 95％CI:3.474, 20.805) and the sex role of"0" (OR=0.397, 95％CI:0.163, 0.969) were statistically significant. Conclusion:The number of HIV self-testing in the past was the promoting factor of couple testing, and the sex role of"0"was the obstacle factor for the testing.

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

目的 评价快速胶体硒法检测指尖血梅毒螺旋体抗体法与梅毒螺旋体抗体凝集法(TPPA)检测血浆结果的一致性.方法 采集梅毒求诊者指尖和静脉血,分别采用快速胶体硒法和TPPA法进行检测,以TPAA法为标准,比较快速胶体硒法的准确性.结果 共检测269例梅毒求诊者,快速胶体硒法阳性率为32.71％,TPPA法阳性率为32.34％,两者差异无统计学意义(x2 =3.84,P＞0.05);快速胶体硒法的假阳性率和假阴性率较低,且敏感性和特异性均较理想,与TPPA法保持较高的一致性.结论 快速胶体硒法检测准确性与TPPA一致性较高,值得在梅毒螺旋体抗体检测中推广.

Objective To examine the trends of HIV prevalence, risk behaviours and HIV testing among men who have sex with men (MSM) in Nanjing. Design Five consecutive cross-sectional surveys. Setting Nanjing, China. Primary and secondary outcome measures HIV and syphilis prevalence, HIV testing rate and factors associated with HIV infection; demographic characteristics and behaviours. Results 649, 669, 577, 633, 503 MSM were recruited from 2013 to 2017. HIV prevalence was 9.9%, 12.3%, 12.5%, 9.8% and 10.1%, respectively. Syphilis prevalence decreased with a range from 10.6% to 5.6%. Risk behaviours like unprotected anal intercourse (UAI) and unprotected virginal sex in the past 6 months decreased, but multiple sex partners and ever used rush popper rose significantly. MSM tested for HIV in the previous year remained stable from 57.0% to 64.1% ( P =0.633). Multivariate analysis showed that tested for HIV in the past year was protective factor against HIV infection. MSM who had UAI in the past 6 months, sex role as receptive and dual, diagnosed with sexually transmitted diseases (STDs) in the past year and currently syphilis infected were risk factors for HIV infection. Conclusions We observed stable high HIV prevalence, a steady HIV testing rate, decreasing syphilis prevalence and UAI among MSM in Nanjing. However, rush popper use rose dramatically. The HIV preventive strategies for MSM including condom promotion, HIV testing expansion and reduction of rush popper use, STDs screening and standardised treatment should be strengthened.