Immune reconstitution efficacy after combination antiretroviral therapy in male HIV-1 infected patients with homosexual and heterosexual transmission.

We aimed to explore the impact of sexual transmission modes on immune reconstitution after combined antiretroviral therapy (cART). We have retrospectively analyzed longitudinal samples from 1557 treated male patients with virological suppression (HIV-1 RNA < 50 copies/ml) for at least 2 years. Both heterosexuals (HET) and men who have sex with men (MSM) patients showed an increasing annual trend in CD4+ T cell counts after receiving cART (HET, ß: 23.51 (cell/µl)/year, 95% CI: 16.70-30.31; MSM, ß: 40.21 (cell/µl)/year, 95% CI: 35.82-44.61). However, the CD4+ T cell recovery rate was much lower in HET patients than MSM patients, determined by both the generalized additive mixed model (P < 0.001) and generalized estimating equations (P = 0.026). Besides HIV-1 subtypes, baseline CD4+ T cell counts and age at cART initiation, HET was an independent risk factor for immunological non-responders (adjusted OR: 1.73; 95% CI: 1.28-2.33). HET was also associated with lower probability of achieving conventional immune recovery (adjusted HR: 1.37; 95%CI: 1.22-1.67) and optimal immune recovery (adjusted HR: 1.48, 95%CI: 1.04-2.11). Male HET patients might have poorer immune reconstitution ability even after effective cART. Early initiation of cART after diagnosis and clinical monitoring for male HET patients should be highly emphasized.

Depression, Loneliness, and Sexual Risk-Taking Among HIV-Negative/Unknown Men Who Have Sex with Men in China.

Research conducted among men who have sex with men (MSM) in high-income countries has demonstrated that negative mental health is one of the significant drivers of HIV infection, and few studies have examined the status of mental health among MSM in China. We sought to describe depression and loneliness and identify their correlates among Chinese MSM. A cross-sectional study was conducted among HIV-negative or unknown status MSM in 2014. Time-location sampling and online convenience sampling methods were employed. Depression was measured via a short version of CES-D (CES-D 10). Loneliness was measured from a single item in CES-D 10. Multivariable logistic regressions were conducted to identify independent correlates of depression and loneliness. A total of 507 individuals participated in the study. Of them, 26.8 and 35.5% reported moderate-to-severe symptoms of depression and feeling lonely, respectively. Depressed participants were more likely to have a sense of hopelessness for the future (AOR 3.20, 95% CI 1.90, 5.20) and report higher levels of internalized homophobia (AOR 2.32, 95% CI 1.47, 3.67). Participants who reported feeling lonely were more likely to have had condomless receptive anal intercourse in the past 6 months (AOR 1.67, 95% CI 1.08, 2.58) and feel hopeless for the future (AOR 2.40, 95% CI 1.60, 3.70). MSM in China have significant rates of depression and loneliness. HIV prevention efforts should address the mental health needs of Chinese MSM such as providing safe environments for social support and role models.

Trends in late HIV diagnosis among men who have sex with men in Jiangsu province, China: Results from four consecutive community-based surveys, 2011-2014.

OBJECTIVES: To examine trends in HIV testing, late HIV diagnosis and associated factors among men who have sex with men (MSM) in Jiangsu province, China. METHODS: Four consecutive community-based cross-sectional surveys were conducted among MSM from 2011 to 2014 in eight cities in the province. Participants were recruited from MSM venues and via the internet. HIV bio-behavioral surveys were conducted to collect demographic and behavioral data and measure HIV infection. HIV-infected participants with CD4 counts less than 350 cells/uL were defined as having a late HIV diagnosis. Chi-square trend tests were used to compare temporal changes over the years and multivariable logistic regression analyses were used to identify factors associated with late diagnosis. RESULTS: A total of 2,441, 2,677, 2,591 and 2,610 participants were enrolled in 2011, 2012, 2013 and 2014, respectively. Testing for HIV in the last 12 months decreased over the time period, from 59.9% to 52.5% (p<0.001). Late HIV diagnosis remained high and steady, ranging from 33.3% to 44.2% over the years with no significant change over time (p = 0.418). MSM who were older than 24 years (aOR = 1.748, p = 0.020 for 25-39 years old; aOR = 3.148, p<0.001 for 40 years old or older), were recruited via internet (aOR = 1.596, p = 0.024), and did not have an HIV test in the past 12 months (aOR = 3.385, p<0.001) were more likely to be late diagnosed. CONCLUSIONS: Our study showed a plateau in HIV testing among MSM in China, in parallel to high levels of late diagnosis. Emerging and innovative strategies such as HIV self-testing and reaching more MSM by internet, both highly acceptable to MSM in China, may reduce late diagnosis.

The Impact of Homophobia and HIV Stigma on HIV Testing Uptake Among Chinese Men Who Have Sex With Men: a Mediation Analysis.

BACKGROUND: Gay and HIV-related stigma and discrimination are major barriers to accessing HIV prevention services among Men Who Have Sex with Men (MSM) worldwide. We aimed to identify modifiable factors that mediate the relationships between gay and HIV-related stigma and discrimination and HIV testing uptake among Chinese MSM. METHODS: We conducted a cross-sectional survey study of 523 HIV-uninfected or unknown HIV status MSM in Jiangsu Province, China between November 2013 and January 2014. Multivariable analyses were conducted to examine the associations among experienced homophobia, HIV stigma, and recent HIV testing. Causal mediation parametric analyses were conducted to assess whether depression and social norms mediated hypothesized associations. RESULTS: Stronger subjective norms toward testing was associated with higher odds of recent HIV testing (adjusted odds ratio [AOR]: 1.10, 95% confidence interval [CI]: 1.01 to 1.21), whereas increasing levels of depression and HIV stigma were both associated with lower odds of recent testing (AOR: 0.96, 95% CI: 0.92 to 0.99; and AOR: 0.91, 95% CI: 0.84 to 0.99, respectively). There was an indirect relationship (natural indirect effect [NIE]) of experienced homophobia on recent testing (ORNIE: 0.96, 95% CI: 0.93 to 0.98) mediated (35.0%) through depression. Furthermore, there was an indirect relationship of HIV stigma on recent testing (ORNIE: 0.98, 95% CI: 0.95 to 0.99) mediated (19.2%) through subjective norms. CONCLUSIONS: Depression and social norms are important mediators of HIV testing uptake among stigmatized Chinese MSM. Therefore, in addition to advocacy efforts and policies that address social-level stigma and discrimination, HIV prevention programs should also address mental health issues and incorporate community-based approaches to changing social norms toward HIV testing.

Comparing Samples of Men Who Have Sex with Men Recruited Online and in Venues, Jiangsu Province, China, 2013.

PURPOSE: Two common methods to sample men who have sex with men (MSM) for HIV research are venue- and internet-based approaches. However, it is unclear which is best to sample Chinese MSM. METHODS: We conducted side-by-side comparisons of time-location sampling (TLS) and an online sample of MSM in Nanjing, China. RESULTS: TLS-recruited MSM tended to be older and of lower socio-economic status compared to online-recruited MSM, whereas online-recruited MSM reported higher risk behavior and lower frequency of HIV testing. CONCLUSION: Significant differences were observed between the two separate samples. Without a gold standard, the choice of sampling method or recruitment approach should be guided by the segment of the population targeted to be reached.

HIV Testing and Awareness of Partner's HIV Status Among Chinese Men Who Have Sex with Men in Main Partnerships.

Many men who have sex with men (MSM) do not use condoms with their main partners, especially if both parties are of the same HIV status. However, significant proportions of MSM have never tested or recently tested and are unaware of their main partners' HIV status. A cross-sectional survey was conducted among 524 MSM in Jiangsu, China in 2013-2014. Time-location sampling and online convenience sampling were used to recruit participants. We compared awareness of HIV status and recent HIV testing between participants who had main partners versus those who did not, and identified factors associated with recent HIV testing among men in main partnerships. Participants in main partnerships were significantly more likely to report recent HIV testing and being HIV-negative instead of HIV-unknown compared to participants in casual partnerships only. Overall, 74.5 % of participants were aware of their main partners' HIV status. Among participants in main partnerships, those who had 2-5 male anal sex partners in the past 6 months and those who reported that their partners were HIV-negative had 2.36 (95 % CI 1.12, 4.97) and 4.20 (95 % CI 2.03, 8.70) fold greater odds of being tested in the past year compared to those who had main partners only and those whose partners were HIV-positive/unknown, respectively. Chinese MSM in main partnerships might be practicing serosorting and may be at lower risk for HIV infection due to increased awareness of main partners' HIV status and higher uptake of recent testing.

[Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in Nanjing].

OBJECTIVE: To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. METHODS: PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. RESULTS: A total of 276 PLWHA were surveyed, According to the evaluation criterion of Center for Adherence Support Evaluation (CASE), 252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking, progress of the disease and side effects, reminding of taking drug and age were correlated with self-reported HAART adherence. CONCLUSION: It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young, suffer from side effects, have no reminding methods for taking drug.

Experiences and correlates of HIV self-testing among men who have sex with men in Jiangsu province, China.

Substantial numbers of Chinese men who have sex with men (MSM) do not access facility-based HIV testing. Self-testing could promote testing uptake among this population. We describe experiences and identify correlates of self-testing among Chinese MSM. A cross-sectional survey was conducted among MSM in Jiangsu from November 2013 to January 2014. Participants were recruited through time-location sampling and from online. Participants were asked a series of questions about HIV self-testing uptake and associated experiences. Logistic regression was used to identify correlates of having ever self-tested for HIV. Of 522 participants, 26.2 % had ever self-tested. Finger stick was the most common self-testing modality (86.1 %). A majority of participants reported that it was "very easy" (43.1 %) or "somewhat easy" (34.3 %) to perform self-testing while lower proportions reported "very confident" (24.1 %) or "somewhat confident" (36.5 %) in the accuracy of their test results. Having ever self-tested was significantly associated with having had 2-5 and 6 or more male anal sex partners in the past 6 months (AOR 2.12, 95 % CI 1.00, 4.49; AOR 4.95, 95 % CI 1.90, 12.87), having ever tested for HIV (AOR 4.56, 95 % CI 1.66, 12.55), and having a friend or friends who self-tested (AOR 7.32, 95 % CI 3.57, 15.00). HIV self-testing can reach untested Chinese MSM and/or increase testing frequency. Peer- or social network-based interventions could futher help encourage self-testing. Monitoring systems should be strengthened to ensure the quality of self-testing kits and provision of essential support services, including post-test counseling and linkage-to-care.