Downloaded from http://journals.lww.com/jaids by BhDMf5ePHKbH4TTImqenVAHxkFJp/XpPk1L/H3vMGwqMxG9jwOd8eHu+WdxxmltmG+Y2f0aqIM4= on 07/30/2018 SUPPLEMENT ARTICLE Prevalence and Correlates of HIV and Syphilis Infections Among Men Who Have Sex With Men in Seven Provinces in China With Historically Low HIV Prevalence Yan Xiao, MD, DrPH,* Jiangping Sun, MD, PhD,* Chunmei Li, MD,† Fan Lu, MD, PhD,* Katherine L. Allen, MSc,‡ Sten H. Vermund, MD, PhD,‡ and Yujiang Jia, MD, DrPH‡ Objectives: To assess HIV and syphilis infection among men who have sex with men (MSM) in Chinese regions with historically low HIV prevalence. Method: A cross-sectional survey was conducted in 20 cities or districts across 4 provinces, 2 autonomous regions, and a munici- pality. Socioeconomic/behavioral risk factors were measured. Blood samples were tested for HIV via enzyme-linked immunosorbent assay and Western blot confirmation and syphilis via rapid plasma reagin and passive particle agglutination test for detection of Treponema pallidum Antibodies. Results: Of 4983 MSM participants, 2.9% were HIV infected (range: 0%–15.1%) and 9.8% were syphilis infected (1.3%–29.3%). Syphilis infection was associated with older age [adjusted odds ratio (AOR) = 2.9; 95% confidence interval (CI): 2.0 to 4.3], not being married or cohabiting (AOR = 0.7; 95% CI: 0.5–0.9), less education (AOR = 1.3; 95% CI: 1.0 to 1.7), inconsistent condom use during anal sex with men (AOR = 1.4; 95% CI: 1.0 to 1.8), and living in inner Mongolia (AOR = 23.9; 95% CI: 9.7 to 58.6), Jilin (AOR = 7.9; 95% CI: 3.4 to 18.3), Heilongjiang (AOR = 7.1; 95% CI: 3.1 to 16.6), Liaoning (AOR = 6.1; 95% CI: 2.6 to 14.2), or Chongqing (AOR = 5.9; 95% CI: 2.5 to 13.9). HIV infection was associated with older age (AOR = 3.7; 95% CI: 2.0 to 6.7), less education (AOR = 2.9; 95% CI: 1.8 to 4.7), inconsistent condom use during anal sex with men (AOR = 1.9; 95% CI: 1.2 to 3.2), syphilis infection (AOR = 2.1; 95% CI: 1.3 to 3.4), and living either in Liaoning (AOR = 8.2; 95% CI: 1.1 to 61.4) or Chongqing (AOR = 57.2; 95% CI: 7.9 to 414.4). Conclusions: HIV and syphilis have reached alarming rates in China’s MSM population, thus, appropriate responses are urgently needed. Key Words: China, drug abuse, HIV, MSM, sexual behavior, syphilis (J Acquir Immune Defic Syndr 2010;53:S66–S73) INTRODUCTION The HIV epidemic in China continues to grow, expanding beyond injection drug users. 1–3 Half of all new cases in 2007 were transmitted sexually. 2,4 Of particular concern is increasing transmission among men who have sex with men (MSM). HIV prevalence in this group is estimated between 1% and 5%. 4–7 Between 2005 and 2007, the cumulative reported HIV cases attributed to MSM increased from 0.4% to 3.3%. 2 Unsafe sex between men accounted for 11% of the estimated new HIV cases in 2007, which is an increase from previous years. 2 Given that MSM in China are not a highlighted high-risk group, this trend is worrisome. Emerging data suggest that MSM are increasing risky activities. Massive internal migration from rural areas to urban cities has occurred, resulting in MSM being more visible and socially connected. 2,4,7,8 This is especially true in large- sized and medium-sized cities with large concentrations of migrants. 2,4,7,8 This social transformation has been associated with higher risk for HIV infection in MSM. 2,4,7–9 In addition to rising HIV prevalence, high syphilis pre- valence (;10%) has been documented in urban MSM. 4–7,10–13 High prevalence of both of these infections can be attributed to high-risk behaviors in MSM. For example, 70% of urban MSM reported having sex with more than 1 partner in the past 6 months. 2 Only 30% used condoms for anal sex, and about half reported not using condoms when having paid sex with a male. 2 A significant number (.25%) of MSM have also had sex with females. 4 These prevalent high-risk behaviors, coupled with increasing syphilis prevalence, make MSM a particularly vulnerable risk group for HIV. Sexually trans- mitted infections (STIs), particularly, for example, syphilis and herpes, are strongly associated with HIV acquisition. 14–17 Recognition and treatment of syphilis are crucial to both HIV and syphilis control and prevention. Without decisive action, MSM could become the second highest prevalent risk group, behind injection drug users, for HIV infection in China. 18 From the *National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China; †Department of Epidemiology and Biostatistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China; and ‡Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. Supported partly by the China Global Fund AIDS Program Round Five, the National Center for AIDS/STD Control and Prevention, the Chinese Center for Disease Control and Prevention, and the Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine. Correspondence to: Jiangping Sun, MD, PhD, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xuanwu District, Beijing 100050, China (e-mail: jpsun@chinaaids.cn). Copyright Ó 2010 by Lippincott Williams & Wilkins S66 | www.jaids.com J Acquir Immune Defic Syndr  Volume 53, Supplement 1, February 1, 2010