Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China

Despite concerted global efforts for years to contain HIV, especially targeting the at-risk groups, occurrence of new infections among men who have sex with men (MSM) continued to increase in the developing world including Africa, China, Taiwan, Myanmar, India and Thailand1,2. Although driven historically by certain high-risk groups like injecting drug users and former blood and plasma donors, in recent past, HIV epidemic in China started to reflect diverse epidemiology and transmission patterns3,4,5,6,7. During 2011, the number of people living with HIV/AIDS (PLWHA) was estimated to be 780,000 in this country, 63.9% of which were infected through sexual transmission7. The proportion of PLWHA infected through male-to-male homosexual route did increase here, from 2.5% in 2006 to 17.4% in 20117. Although improvements in the infrastructure and coverage of the National HIV surveillance system in China could partially explain this observed increasing trend, potential reasons for actual rise should also be explored. During 2011, in this country, the estimated size of MSM population was 5–10 million with an HIV prevalence of 6.3%, substantially higher than the corresponding value in the general population (0.058%). These male-to-male homosexually transmitted HIV infections accounted for 29.4% of the estimated 48,000 new infections in 2011, despite implementation of comprehensive control measures for years by Chinese Government3,4,6,7,8,9,10. Occurrence of other sexually transmitted infections (STIs), for example syphilis and hepatitis [including hepatitis C (HCV)], were reported to be high among MSM potentially attributed to their high-risk sexual behaviors and lower coverage of preventive measures8,9,10,11,12,13,14. Major barriers included social taboos and discrimination, for which Chinese MSM remained mostly hidden8,13. Majority of the studies conducted among MSM in China till date had limited applications in terms of extrapolation to bigger population, owing to non- representative sampling, methodological inconsistencies and potential vulnerability to systematic errors13,15. Established socio-demographic, environmental, behavioral and policy related contextual risk factors for HIV were all found to be largely inter-related. Thus having a deeper understanding of the interplay between such risk factors appeared to be mandatory for further reduction in spread of HIV from and within the Chinese MSM population. Therefore, in order to make a tangible and sustained preventive impact on HIV epidemic among MSM in this country, it was essential to conduct detailed explorations of reliable and accurate behavioral data so that the findings could be translated into effective multilevel public health interventions to combat the epidemic16,17,18. There was also a pressing need for additional research on changes in the dynamics of HIV and STI epidemics and risk behaviors for providing adequate insight regarding need assessment, program planning, and comprehensive policy response. But studies investigating such trends in prevalence of HIV, other STIs (including syphilis and HCV) and risk behaviors among Chinese MSM were limited. Thus a serial cross-sectional study was called for to determine the trends of the aforementioned parameters and their interplay involving a multistage sample of MSM that could ensure somewhat national-level representativeness (as much as possible).