A qualitative exploration of the role of antiretroviral therapy on Chinese rural life.

OBJECTIVE: To explore factors influencing the quality of life of people living with HIV/AIDS (PLHA) and receiving antiretroviral therapy (ART) in rural China. METHODS: In-depth interviews with 20 PLHA were conducted in March 1999. Participants were recruited from the USAID-funded Longitudinal Enhanced Evaluation of ART Project, which tracks a cohort of eligible PLHA receiving treatment at five collaborating treatment centers in Guangxi Autonomous Region, China. An interview guide (semi-structured with open-ended questions) was developed to provide a qualitative examination of the quality of life of PLHA. RESULTS: Participants identified that ART affects physical health, including the experience of pain, side effects, and opportunistic infections. ART imposes lifestyle constraints such as reduced mobility due to drug procurement, and social restrictions due to the daily drug regimen. Participants discussed the psychological burden of taking drugs, and the fear of accidental transmission to others, or having their disease status known by others, as well as optimistic feelings about their future due to ART. ART poses a significant drain on individual's economic resources due to related medical costs, and inability to seek seasonal migrant labor due to reduced mobility. CONCLUSION: While China's national free ART program improved the physical health of those surveyed, their social and economic needs were left unaddressed. To improve life outcomes for PLHA, and by extension, the wider Chinese population, quality of life measures should be included when evaluating the success of the ART program.

Association of TNF-alpha-238G/A and 308 G/A gene polymorphisms with pulmonary tuberculosis among patients with coal worker's pneumoconiosis.

OBJECTIVES: Tumor necrosis factor-alpha (TNF-alpha) may play an important role in host's immune response to mycobacterium tuberculosis (M. tuberculosis) infection. This study was to investigate the association of TNF-alpha gene polymorphism with pulmonary tuberculosis (TB) among patients with coal worker's pneumoconiosis (CWP). METHODS: A case-control study was conducted in 113 patients with confirmed CWP complicated with pulmonary TB and 113 non-TB controls with CWP. They were matched in gender, age, job, and stage of pneumoconiosis. All participants were interviewed with questionnaires and their blood specimens were collected for genetic determination with informed consent. The TNF-alpha gene polymorphism was determined with polymerase chain reaction of restriction fragment length polymorphism (PCR-RFLP). Frequency of genotypes was assessed for Hardy-Weinberg equilibrium by chi-square test or Fisher's exact probability. Factors influencing the association of individual susceptibility with pulmonary TB were evaluated with logistic regression analysis. Gene-environment interaction was evaluated by a multiplicative model with combined OR. All data were analyzed using SAS version 8.2 software. RESULTS: No significant difference in frequency of the TNF-alpha-308 genotype was found between CWP complicated with pulmonary TB and non-TB controls (chi2 = 5.44, P = 0.07). But difference in frequency of the TNF-alpha-308 A allele was identified between them (chi2 = 5.14, P = 0.02). No significant difference in frequencies of the TNF-alpha-238 genotype and allele (P = 0.23 and P = 0.09, respectively) was found between cases and controls either, with combined (GG and AA) OR of 3.96 (95% confidence interval of 1.30-12.09) at the -308 locus of the TNF-alpha gene, as compared to combination of the TNF-alpha-238 GG and TNF-alpha-308 GG genotypes. Multivariate-adjusted odds ratio of the TNF-alpha-238 GG and TNF-alpha-308 GA genotypes was 1.98 (95% CI of 1.06-3.71) for risk for pulmonary TB in patients with CWP. There was a synergic interaction between the TNF-alpha-308 GG genotype and body mass index (OR = 4.92), as well as an interaction between the TNF-alpha-308 GG genotype and history of BCG immunization or history of TB exposure. And, the interaction of the TNF-alpha-238 GG genotype and history of BCG immunization or TB exposure with risk for pulmonary TB in them was also indicated. CONCLUSIONS: TNF-alpha-308 A allele is associated with an elevated risk for pulmonary TB, whereas TNF-alpha-238 A allele was otherwise.

An HIV/AIDS intervention programme with Buddhist aid in Yunnan Province.

BACKGROUND: The prevalence of HIV/AIDS in Chinese ethnic minorities is an important component of China's AIDS issues. In this study, we launched an intervention programme in Yunnan Province of China, where the Dai people live, to carry out the community-based HIV/AIDS health education and behavioral interventions on ordinary Dai farmers. The Dai people believe in Theravada Buddhism. METHODS: Four rural communities were randomly divided into two groups. In one group (Buddhist group), HIV/AIDS health education and behavioral intervention were carried out by monks. The other group (women group) was instructed by women volunteers. The intervention continued for one year and the data were collected before and after the intervention project. RESULTS: In the Buddhist group, the villagers' AIDS related knowledge score was boosted from 3.11 to 3.65 (P < 0.001), and some indices of the villagers' behavior using condoms improved after the intervention. But this improvement was poorer than that in the women group. In the Buddhist group, the villager's attitude score towards the people living with HIV and AIDS (PLWHA) also increased significantly from 1.51 to 2.16 (P < 0.001). CONCLUSION: The results suggested that the Buddhist organization has limited success in promoting the use of condoms, but plays an important role in eliminating HIV/AIDS related discrimination.

HIV/AIDS related discrimination in health care service: a cross-sectional study in Gejiu City, Yunnan Province.

OBJECTIVES: To investigate discrimination against people living with HIV (PLWH) and its impacts. METHODS: Forty people who were either HIV positive (7/40) or had high risk behavior (33/40) were interviewed. Focus group discussion was held in the interview with people who were suspected to be infected with HIV, and in-depth interview was conducted in the survey of HIV positive persons whose privacy was strictly protected to ensure the confidentiality of the collected information. RESULTS: It was identified that six forms of discrimination against people living with HIV occurred in health care service in Gejiu, including speaking to patients in an insulting manner, refusing to provide health care service, delaying treatment, treating differently, uncovering patients' privacy, and over-protecting themselves against patients. Discrimination against people living with HIV greatly affected their health conditions. CONCLUSIONS: Discrimination against people living with HIV in health service has negative impact on their physical and mental health.

Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation - a factorial survey of medical students in China.

BACKGROUND: HIV/AIDS related stigma interferes with the provision of appropriate care and support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as if it occurs in isolation, separate from the co-stigmas related to the various modes of disease transmission including injection drug use (IDU) and commercial sex (CS). In order to develop better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an experimental study for disentangling the layering of HIV/AIDS related stigmas. METHODS: The study used a factorial survey design. 352 medical students from Guangzhou were presented with four random vignettes each describing a hypothetical male. The vignettes were identical except for the presence of a disease diagnosis (AIDS, leukaemia, or no disease) and a co-characteristic (IDU, CS, commercial blood donation (CBD), blood transfusion or no co-characteristic). After reading each vignette, participants completed a measure of social distance that assessed the level of stigmatising attitudes. RESULTS: Bivariate and multivariable analyses revealed statistically significant levels of stigma associated with AIDS, IDU, CS and CBD. The layering of stigma was explored using a recently developed technique. Strong interactions between the stigmas of AIDS and the co-characteristics were also found. AIDS was significantly less stigmatising than IDU or CS. Critically, the stigma of AIDS in combination with either the stigmas of IDU or CS was significantly less than the stigma of IDU alone or CS alone. CONCLUSION: The findings pose several surprising challenges to conventional beliefs about HIV/AIDS related stigma and stigma interventions that have focused exclusively on the disease stigma. Contrary to the belief that having a co-stigma would add to the intensity of stigma attached to people with HIV/AIDS, the findings indicate the presence of an illness might have a moderating effect on the stigma of certain co-characteristics like IDU. The strong interdependence between the stigmas of HIV/AIDS and the co-stigmas of IDU and CS suggest that reducing the co-stigmas should be an integral part of HIV/AIDS stigma intervention within this context.

[Relationship between smoking and risk of esophageal cancer in 103 areas in China: a large-scale case-control study incorporated into a nationwide survey of mortality].

OBJECTIVE: To examine the relationship between smoking and risk of esophageal cancer (EC), and present a theoretical framework of control selection in population-based case-control study which was incorporated into a nationwide retrospective survey of mortality in China. METHODS: A large-scale population-based case-control study was incorporated into the nationwide retrospective survey of mortality conducted 1989 - 1991 in 24 urban cities selected by non-random sampling and 79 rural counties selected from 3000 counties included in the 1973 - 1975 cancer distribution survey by random sampling during. A questionnaire survey was conducted by home visit to investigate the death causes and smoking history of 19 734 deceased male adults who died of esophageal cancer during 1986 - 1988 at the age >or= 35. Two control groups were set up to undergo questionnaire survey by home visit to investigate the smoking history of the deceased persons and the informants. Control group I included the surviving spouses or other informants of 31 989 male adults who died of non-malignant digestive diseases during 1986 - 1988 at the age >or= 35, and control group II included 104 846 male spouses of the deceased female adults who died of different causes during 1986 - 1989 at the age >or= 35. The relative risks and population smoking attributable risks for EC were calculated using non-conditional logistic model, and the results were compared for consistency between the analyses using two different control groups. RESULTS: The EC absolute death rates were higher in the smokers than in the non-smokers in all urban and rural area groups. The total EC absolute death rate per 1000 among the non-smokers vs. smokers was 0.37:0.65 in the urban areas, 0.99:1.29 in the inland rural areas, and 1.09:1.62 in the coastal rural areas in the control group I, and there was a similar trend in the control group II. There was a significant dose-response relation between the period of smoking and the death risk of EC and between the daily cigarette consumption and the death risk of EC. The risk ratios, for example, for cigarette per day < 10, 10-, and 20- in the urban men were 1.42, 1.82, 2.22 in the control group I (trend test P < 0.01), and 1.57, 1.95, and 3.18 in the control group II (trend test P < 0.01). CONCLUSION: Smoking is an important risk factor for mortality from EC in China. Investigating the surviving spouses of the deceased patients is a creative, effective, and feasible trial, with the prerequisite of whole population-based survey, in study of the main types of death and the relevant risk factors.

Smoking and mortality from esophageal cancer in China: a large case-control study of 19,734 male esophageal cancer deaths and 104,846 living spouse controls.

An innovative population-based case-control study was conducted in a national mortality survey to assess the hazards of tobacco use on esophageal cancer among Chinese men. Cases were 19,734 males aged 35 years or older, who died of esophageal cancer during 1986-1988. Controls were 104,846 male living spouses of the same age when their wife died (of any cause) during the same period in the same county or city. The absolute esophageal cancer death rates were higher in smokers than those in nonsmokers in all geographical groups. The relative risks for esophageal cancer were 1.88 (95% CI: 1.73-2.05) and 1.39 (95% CI: 1.28-1.50) in urban and rural men, respectively, after adjustment for other relevant covariates including age group (5 years) and locality. When the calculation was restricted to men aged 35-69, the risk ratios for current cigarette smokers increased significantly with increasing number of cigarettes smoked daily and duration of smoking. Tobacco use, in any form, is an important risk factor for esophageal cancer in Chinese men. Selecting living spouses as controls is a unique and useful approach in the design of case-control studies of cigarette smoking.

[Ponderal index at birth predicts metabolic syndrome in mid-aged Chinese].

OBJECTIVE: To examine the association between Ponderal index (PI) at birth and metabolic syndrome during middle age. METHODS: Totally, 975 adults (494 men and 481 women) aged 41-52 from the study cohort of Fetal Origin of Adult Disease were recruited in the study for clinic examinations, involving anthropometry and measurements of blood pressure, fasting and 2 hr plasma levels of glucose and insulin, serum lipid profile. Their HOMA-insulin resistance (IR) index was estimated. Metabolic syndrome (MS) was diagnosed according to 1999 WHO definition. Multivariate logistic regression analysis was used to estimate the effect of PI on MS and the interaction between PI at birth and body mass index (BMI) in adulthood. RESULTS: Prevalence of MS was 18.7% in this mid-aged population, 24.8%, 19.4%, 16.3% and 14.0% in those with less than the 25th percentile, the 25th to less than the 50th percentile, the 50th to less than the 75th percentile and more than 75th percentile of PI at birth, respectively, in a decreasing trend (chi2 M-H for trend=9.938 adjusted for gender, P=0.002). Logistic regression analysis showed that both PI at birth and BMI during adulthood could influence their occurrence of MS (beta=-0.125, P=0.002, for PI; and beta=0.430, P=0.000, for BMI). A synergistic effect between PI at birth and BMI in adulthood was observed in this population. Persons who were thin at birth with PI less than the 25th percentile, and became overweight with BMI greater than or equal to 24 kg/m2 later in their life, were at higher risk of suffering from metabolic syndrome (OR=29.1, 95% CI=13.6-62.1), in comparison with those who became overweight during adulthood from a higher PI at birth (OR=16.0, 95% CI=7.9-32.3) and those who were thin at birth and remained a appropriate BMI during their adulthood (OR=2.0, 95% CI=0.7-5.7). Attributable fraction of the interaction to MS was 34.6%. CONCLUSIONS: Thin at birth was a predictor for later occurrence of metabolic syndrome, as well as an effect modifier for the association between of later BMI and metabolic syndrome, i.e., overweight later in his life was most deleterious for a person with growth retardation at birth.

HIV/AIDS-related discrimination in Shanxi rural areas of China.

OBJECTIVE: In order to explore the features of discrimination against people with HIV/AIDS in rural areas, a community-based intervention was carried out in two pilot communities of X County of Shanxi Province from September 2002 to October 2003. METHODS: Data were collected using qualitative methods (in-depth interview and focus group discussion) and anonymously structured questionnaires. RESULTS: (1) Severe discrimination against people infected with HIV/AIDS was revealed in the target communities. However, the response to HIV/AIDS was different in each community. (2) People were reluctant to disclose their HIV status or get tested for HIV, which endangered their sexual partners to contract HIV through unprotected sexual intercourses. (3) Attitudes towards people infected with HIV/AIDS varied. (4) Public education promoted a better understanding of HIV/AIDS which in turn improved community attitudes and behaviors towards people with HIV/AIDS. CONCLUSION: HIV/AIDS-related discrimination undermines both individuals' and communities' responses to HIV/AIDS and may be a serious obstacle towards effective HIV/AIDS prevention and control.

Epidemiology of HIV and sexually transmitted infections in China.

As the most populous country in the world, China has been confronted with the huge challenges that HIV and sexually transmitted infections pose. The HIV infection rate among adults is lower than 0.1%, however, the estimated number of HIV infections sits around one million, according to the estimation of some experts. HIV infection is highly prevalent in some regional areas of China and the incidence rate of sexually transmitted infections has sharply increased since the 1980s. The number of HIV infections may reach 10 million if no effective measures are taken. This article aims to outline the profile of the epidemic in China as well as to elaborate on the contributing factors and the response of the government and community.

[Cigarette smoking and Parkinson's disease: a population based case-control study].

OBJECTIVE: To explore the association with cigarette smoking for Parkinson's disease (PD). METHODS: One hundred and fourteen PD cases and 205 controls matched on gender and race were recruited from ongoing PD prevalence survey and identified at the neurological clinic of Peking Union Medical College Hospital. Face to face questionnaire interview was carried out and data on smoking and alcohol consumption were analyzed in a population-based case control study. RESULTS: With never-smokers as the reference category, we observed reduced risk for PD among ever smokers (OR = 0.49, 95% CI: 0.30 - 0.79) current smokers (OR = 0.44, 95% CI: 0.23 - 0.86) and ex-smokers (OR = 0.54, 95% CI: 0.30 - 0.96). When comparing with non-smokers, the ever smokers stratified by years of smoking had an inverse association with those whose smoking history longer than 20 years (OR = 0.35, 95% CI: 0.18 - 0.70) and an mild protective association with those who smoked less than 20 years (OR = 0.61, 95% CI: 0.35 - 1.07). Those who had quitted smoking for more than 20 years were less likely to have the disease than never smokers, and those who had quitted for less than 20 years were least likely to have PD. Those current smokers were still least likely to have the disease. Significant inverse gradient with pack-day smoker (trend P < 0.05), and the inverse association for cigarette smoking and PD were found not bing confounded by alcohol consumption. CONCLUSION: The inverse association between PD and cigarette smoking and history of cessation was found. Further studies need to provide biochemical evidence on the relation between smoking and its protective effect on PD.

Parkinson's disease and smoking: an integral part of PD's etiological study.

OBJECTIVE: To explore the association of Parkinson's disease (PD) with cigarette smoking. METHODS: One hundred of fourteen PD patients were compared with 205 control subjects who were matched by gender, race and residency. A previously validated questionnaire including smoking, alcohol/tea consumption as well as some other environmental exposure data was administered. RESULTS: With never-smokers as the reference category, we observed reduced risk for PD among ever smokers (OR=0.49, 95% CI: 0.30 to 0.79) current smokers (OR=0.44, 95% CI: 0.23 to 0.86) and ex-smokers (OR=0.54, 95% CI: 0.30 to 0.96). When ever smokers were stratified by years of smoking, there was an inverse correlation between those whose smoking history was longer than 20 years (OR=0.40 95% CI: 0.21 to 0.81) and an even mild protective correlation between those who smoked less than 20 years (OR=0.57, 95% CI: 0.33 to 0.99). Those who had quitted smoking for more than 20 years were less likely to have the disease than never smokers, and those who had quitted for less than 20 years were least likely to have PD, while those who were current smokers were still least likely to have the disease. We found significant inverse gradient with pack-day smoking (trend P<0.05), and the inverse correlation between cigarette smoking and PD was not confounded by alcohol/tea consumption and other confounding bias. CONCLUSIONS: The inverse correlation between Parkinson's disease risk and smoking as well as the trend of gradient dose response is again observed in our study. More future researches are needed to confirm these correlations and to explore further biochemical evidence.

AIDS-related knowledge, condom usage among medical postgraduates.

OBJECTIVE: To investigate the knowledge about safety/unsafety of sexual acts relating to HIV transmission, levels of embarrassment related to condom and condom usage among medical postgraduates. METHODS: From August to December, 1998, a self-administered anonymous questionnaire was given to 271 new medical postgraduates from two medical colleges of Beijing and Hebei Province. RESULTS: There was a hazy understanding of the protective function of condom from AIDS among medical postgraduates. Only 14.4% medical postgraduates persisted in using condom, and 27.94% had never or almost never used it. The levels of embarrassment about condom were high. The median score was 3.55 +/- 0.98. Whether to use condom was related with the attitudes to condom, but not to AIDS. CONCLUSION: There was some misunderstanding about condom and inconsistent condom usage in medical postgraduates. So it is essential to strengthen the sexual health education among them.