SUPPLEMENT ARTICLE The HIV Epidemic in Yunnan Province, China, 1989–2007 Manhong Jia, MD,* Hongbing Luo, MD,* Yanling Ma, MD,* Ning Wang, MD, PhD,† Kumi Smith, MPIA,† Jiangyuan Mei, MD,* Ran Lu, MD,* Jiyun Lu, MD,* Liru Fu, MD,* Qiang Zhang, MD,* Zunyou Wu, MD, PhD,† and Lin Lu, MD* Objective: To investigate the characteristics and trends in the HIV epidemic in Yunnan province, China, between 1989 and 2007. Methods: Statistical analysis of serological data from voluntary testing and counseling sites, medical case reports, mass screenings, sentinel surveillance, and other sources. Results: By 2007, a cumulative total of 57,325 cases of HIV infection were reported in Yunnan, and unsafe drug injection practices and unsafe sexual behaviors were identified as the dominant modes of transmission. HIV affects injecting drug users most, particularly in Jingpo, Dai, and Yi ethnicities, more than 40% in 7 counties. HIV prevalence rates among female sex workers (FSWs) increased from 0.5% in 1995 to 4.0% in 2007; among men who have sex with men, from 4.0% in 2005 to 13.2% in 2007; among male clients of FSWs, from 0% in 1995–1997 to 1.8% in 2007; among male sexually transmitted disease clinic attendees, from 0% in 1992 to 2.1% in 2007; among pregnant women from 0.16% in 1992 to 0.5% in 2007; and among blood donors, from 0.0075% in 1992 to 0.084% in 2007. Conclusions: The HIV epidemic in Yunnan has progressed to a concentrated epidemic. Future efforts must focus on not only groups at risk for primary infection (injecting drug users, men who have sex with men, and FSWs) but also on their low-risk sexual partners. Key Words: case report, China, epidemiology, HIV/AIDS, sentinel surveillance (J Acquir Immune Defic Syndr 2010;53:S34–S40) INTRODUCTION The HIVepidemic in Yunnan first appeared in 1989 with the discovery of 146 infected injecting drug users (IDUs) in Ruili, a town bordering Myanmar and situated along the drug trafficking routes channeling heroin into China from Southeast Asia’s opium-producing ‘‘Golden Triangle’’region. 1 Although this region has a long history of opium use, the advent of using injection needles as a common form of drug administration in the late 1980s created an efficient transmission mode that spread HIV among IDUs. Surveillance data shows HIV had appeared in geographically disparate groups of IDUs begin- ning around 1995 and has since spread with increasing mom- entum. Within several years, 8 counties were reporting HIV prevalence rates of more than 40%. By 1999, all 16 prefectures of Yunnan had reported HIV infections, and despite making up only 3% of the national population, Yunnan’s reported cases of HIV accounted for 34.8% of total HIV cases in China. 2 Moreover, prevalence rates among some high-risk groups have already reached crisis proportions in certain areas; rates as high as 74.5% were reported among IDUs 2 and was approxi- mately 10% among female sex workers (FSWs). 3–4 In 1992, the provincial government began using a sentinel surveillance system to track the epidemic. As a result, Yunnan’s HIVepidemic is one of the most consistently and thoroughly tracked in China, providing valuable insight into long-term trends and characteristics. 4–6 Additionally, many of China’s earliest pilot studies testing intervention methods occurred in Yunnan. 7–9 Yunnan has been described as a ‘‘key HIVepicenter in China,’’ 10 and an in-depth analysis of its long-term epidemi- ological trends provides a lens of examining how HIV is spread in Chinese settings. Yunnan can also act as a regional case study to which other regions can compare their own epidemiological trends and use Yunnan’s experience to inform their choice of intervention methods. METHODS Two types of data were used in this article: sentinel surveillance data and reported cases of HIV infection via multiple strategies of HIV testing. Sentinel Surveillance In 1992, a standardized HIV sentinel surveillance system was established to consolidate information at the provincial level. 10 By 2007, 89 sentinel sites were set up conducting regular surveillance among IDUs (18 sites; sample size: 100– 200 per site), FSWs (33 community-based sites and 1 women From the *Yunnan Center for AIDS/STD Transmitted Disease Control and Prevention, Yunnan Center for Disease Control and Prevention, Yunnan, China; and †National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. Supported by the Tenth 5 Years of Key Technologies Research and Development Program (2004BA719A14-1) and the China Multidisci- plinary AIDS Prevention Training Program with NIH Research Grant # U2R TW 006917 and U2R TW 006918, funded by the National Institutes of Health, the Fogarty International Center, the National Institute of Drug Abuse, and the National Institute of Mental Health (China ICOHRTA, with Principal Investigator Z. Wu). M.J. and H.L. Equally contributed. Correspondence to: Lin Lu, MD, Yunnan Center for Disease Control and Prevention, Yunnan 650022, China (e-mail: lulin@yncdc.cn). Copyright Ó 2010 by Lippincott Williams & Wilkins S34 | www.jaids.com J Acquir Immune Defic Syndr  Volume 53, Supplement 1, February 1, 2010