Download HIV Epidemic among MSM in China(cont.)

HIV/AIDS Research Progress and Prevention
for Men Who Have Sex with Men (MSM) in
China and the United States
Yang Wang
School of Biomedical Engineering, Sciences and Health Systems
Department of Microbilogy and Immunology
Drexel University School of Medicine
Epidemiology of HIV in United States
In 2009, people living with HIV or AIDS in the world: 33.3 million.
In US, by the end of 2010, 1,200,000 adults and children were estimated to
be living with HIV. Among them, 17,774 died of HIV-related causes in 2009.
UNAIDS Global AIDS Response Progress Reporting 2012
UNITED STATES OF AMERICA Country Progress Report
Epidemiology of HIV in China
In China, by the end of 2011, 780,000 adults and children were
estimated to be living with HIV. Among them, 28,000 died of HIVrelated causes in 2011.
By August of 2010, cumulative number of PLHIV receiving ART
was 100,000 in China.
Research Progress on HIV Vaccine

Until now, all the HIV vaccine
trials are proven to be
unsucsessful due to hypermutation and immune evasion
of HIV

failure of new HIV vaccine trial
(HVTN505):a vaccine regimen
consisting of a DNA vector
encoding HIV-1 Gag, Pol, Nef
and Env proteins followed by a
recombinant adenovirus type 5
(rAd5)
HIV Treatment- HARRT

HAART is the name given to
aggressive treatment regimens used
to suppress HIV viral replication
and the progression of HIV disease.

The usual HAART regimen
combines three or more different
drugs such as two nucleoside
reverse transcriptase inhibitors
(NRTIs) and a protease inhibitor
(PI), two NRTIs and a nonnucleoside reverse transcriptase
inhibitor (NNRTI) or other such
combinations.
HIV Cure:
After 2012, HIV cure gradually became a hotspot in HIV
reseach. It commonly includes novel drugs, gene therapy, and bone
marrow transplantation (BMT)
CM Durand, et al., Nature, 2013
News, Nature, 2013
Berlin Patient
Timothy Brown, also
known as “The Berlin
Patient,” is thought to be
the only individual
functionally cured of
HIV.
HIV Epidemic among MSM in US

In 2008, the US Centers for
Disease Control and Prevention
(CDC) estimated that at the end
of 2006, approximately 1.1 million
persons (prevalence rate 447.8 pe
100 000 or 0.45%) were living wit
HIV in the United States. Of
these, nearly half (48.1%) were
MSM.
Centers for Disease Control and Prevention. HIV prevalence
estimates: United States, 2006. MMWR 2008;
HIV Epidemic among MSM in US (cont.)
1. HIV prevalence varies extensively, with the highest
prevalence figures observed for low socioeconomic
status men, African Americans, injection drug users,
and heavy non-injection substance users
2. HIV prevalence was higher among MSM in their
40s, those who were fully out, and more strictly
homosexual men or men who self-identified as gay.
Joseph A. Catania et al. American Journal of
Public Health, 2001
HIV Epidemic among MSM in US (cont.)
3. New York City and Los Angeles contain the 2 largest
MSM communities in the United States, Chicago
contains a focal community for MSM in the northern
Midwest, and San Francisco has the highest-density
MSM neighborhoods of any US city. These 4 cities
alone hold more than one third of all MSM AIDS cases
in the United States. Furthermore, these cities also are
common vacation destinations for many MSM and thus
may provide geographic foci from which HIV infection
may spread to other areas of the country.
HIV Epidemic among MSM in US (cont.)
4. Overall, the estimated HIV incidence among black MSM was 8.0
times higher than among white MSM. Of new infections in
MSM, 46% were in whites, 35% were I n african americans and
19% were in Hispanics.
5. When many MSM saw close friends, partners and lovers die—gay
communities adopted a range of practices to reduce the risk of
infection successfully by changing sexual behaviours. Regretfully,
these achievements did not last; many other developed countries
also recorded a resurgence in the number of MSM newly
diagnosed with HIV/AIDS since the mid-1990s. The main
reason for the re-emergence of the disease was the come-back of
risky sexual behaviours, triggered by wider social and cultural
changes, greater social acceptance for gay men and, somehow
unpredictably, the introduction of more efficient drugs

6. Another main factor for the resurgence of AIDS
among the gay communities in US is, ironically, the
efficiency of HAART—AIDS Fatigue.
7. the rise of internet-dating sites has increased the
ease with which new partners can be found—to
facilitate HIV infection among MSM.
HIV Epidemic among MSM in China
1. In mainland China, several recent crosssectional studies among MSM show HIV
prevalence ranging from 0.5% in Jinan to 8.5%
in Chongqing and 9.1% in Chengdu
(prevalence greater than 10% in several
southwest cities). The mean infection rate
among MSM is 5.0% in China(2.0% in US).
HIV Epidemic among MSM in China(cont.)
2. Some sociologists found that 7.0% male college
students had homosexual inclination (scholars in China
often put bisexuals into homosexuals) . Suprisingly,
college male students that commonly are thought to be
low prevalence for HIV have become high-risk
population for HIV infection
3. In recent years, older gay men account for more and
more HIV infection.
HIV Epidemic among MSM in China(cont.)
4. Owing to being Restricted by political, cultural
and custom elements, China is lagging behind in
study on relationship between MSM and
HIV/AIDS, and lacking involved data and
corresponding health interventions as well
HIV Epidemic among MSM in China(cont.)
5. Due to ingrained perception of marrige and childbearing,
MSM in China present different chacteristic compared with
MSM in US.
As for China, 70-80% of welleducated gays or bisexuals in
metropolitan areas has or will get married with women. The
proportion in rural areas may climb to 90% and marriage with
women usually becomes inevitable because the incoming severe
societal pressure if they do not get married. This suggests that
MSM could also potentially act as a bridge to transmit HIV to
the general female population. MSM in developed nations
scarcely had sex or get married with women and the spread is
confined to MSM community
HIV Epidemic among MSM in China(cont.)
6. There are 56 ethnicities in China, the majority of which is the
Han ethnicity (91.5%), and Chinese ethnic minority MSM are
considered to be a high-risk subpopulation of MSM. MSM in
Kunming, Yunnan Province found that the incidence of HIV
among minority MSM was 10.1/100 PYs, which was significantly
higher than Han-ethnic MSM (2.3/100 PYs). Additionally,
minority MSM are also at risk of spreading HIV to the general
population. Ethnic minority MSM were more likely to have sex
with women compared to MSM who are of Han ethnicity. HIV
prevention and behavioral intervention programs should focus
their efforts on targeting these subpopulations of student and
minority MSM.
HIV Epidemic among MSM in China(cont.)
7. There are many new factors that can significantly
increase the rate of HIV transmission among men who
have sex with men (MSM), including low HIV testing
rates, high HIV incidence, high prevalence of syphilis
infection and migration.
The newly emerging HIV epidemic among MSM has
been fueled by several factors, including low HIV
testing rates, high prevalence of syphilis, persistent
stigma against homosexuality and traditional concepts
toward marriage and childbearing
HIV Epidemic among MSM in China(cont.)
8. Low HIV testing rates and high rates of highrisk sexual behaviors are major factors that
correlate with the HIV epidemic among MSM.
The effect of traditional Chinese culture is
another major factor that iscorrelated with the
HIV epidemic among MSM in China.
Prophylaxis for HIV among MSM
1. Efforts should be made to reduce stigma toward MSM. Stigma
and discrimination toward MSM within families and in the wider
community remains enormous and has become the major barrier
for MSM access to AIDS programs.
2. Carry out HIV test among MSM periodically and establish more
sentinel surveillance sites to track HIV progression
The number of sentinel surveillance sites focused on this group
has increased from 3 sites in 2005 to 9 sites in 2007 to 56 sites in
2009. The percentage of MSM tested for HIV who knew their
result increased from 32.7% in 2007 to 44.9% in 2009 in China
Prophylaxis for HIV among MSM
As trategic plan and guidelines for conducting
interventions among MSM were developed in
2006 with substantial input from MSM
community leaders. These programs reached
anaverage of 85,727 MSM per month in 2009
and the percentage of MSM who had used a
condom during their last sexual encounter
increased from 64.4% in2007 to 73.1% in 2009
Prophylaxis for HIV among MSM
3. NGO for MSM should be given more freedom and less control
by government to better facilitate HIV prevention among MSM.
4. condom promotion among HIV positive MSM is another
effective strategy to prevent HIV transmission, especially
because it is very inexpensive compared with administering early
ART.
5. expand media, education, and HIV testing programs among
MSM Compared with early HIV treatment strategies.
Looking at What does Scientists Say
Conclusion
1. HIV has become a chronic infectious disease due to
HARRT adoption. However, HIV vaccines are not
developed sucssesfully.
2. MSM community is still the high-risk population in
transmitting HIV. HIV epidemic among MSM between US
and China not only share a variety of similarities, but also
differnces due to cultural difference and political system.
3. in terms of HIV prevention among MSM community,
corresponding measures should be adopted for prophylaxis
Acknowledgement
School of Publich Health, Drexel
University:
Randel Sell, Ph.D,C MPH
William Way LGBT Community
Center in Philadelphia :
Chris Bartlett, Director
Avis, Staff
China CDC:
Yiming Shao, M.D, Ph.D
Guodong Mi, M.D, Ph.D
Sex Health Center of the Affiliated
Hospital of Medical College Qingdao
University, China:
Beichuan Zhang, M.D
“Tongai” Gay Center, China
Xiaohan Xiang, Director
“Tongzhiyifanren” Gay Center, China
Hui Du, Coordinate Director
Pray for passengers aboard Malaysia
Airlines flight MH370
153 Chinese and 38 Malaysians disappeared!!!