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Rapid increase of HIV infections in MSM in China
There has been a surge in new HIV infections among men who have sex with men (MSM) in China in recent years, indicating that the HIV epidemic in the country is in transition. China’s HIV epidemic is concentrated to injecting drug users (IDUs), female sex workers, and MSM. Yet there are concerns that the complex nature of China’s epidemic - in that many of these sub-groups overlap with each other - means that it will become more generalised among the wider population, if HIV prevention interventions are not targeted among these groups, and MSM in particular.
In a study published last week in the Lancet Infectious Diseases, the authors research HIV epidemic trends in the country. It is the first study of its kind to take into account independent and government survey data at both national and provincial level. Like much of the Asia region, China’s overall HIV prevalence is relatively low (less than 0.1 percent among adults). However there are significant variations in geography (5 of their 31 provinces accounting for nearly all new HIV infection) and modes of transmission among specific sub-populations, increasing the likelihood of the epidemic spreading among the general population.
The authors of the study state that this increase in new infections among MSM might be related to greater openness of homosexuality in China - meaning that more men are willing to be in homosexual relationships. They also point to the ‘dynamic nature’ of networks of MSM in China, as MSM in China are also more likely to be bisexual. The authors report that an estimated 17-35 percent of MSM are married, and more than a quarter have reported to have had sex with a woman in the past 6 months. Furthermore, the percentage of men who disclose their status and use condoms with their wives is also low. This indicates that wives of MSM are increasingly at risk of HIV infection.
In the past, injecting drug use was the most important driver of the HIV epidemic in China and as a result, the government did well in scaling up access to harm reduction programmes. However, there are few programmes targeting MSM at national level, and many of this population have little access to these programmes. The authors state: “These programmes are embedded as components of broader HIV prevention programmes for the most at-risk populations and do not specifically address the characteristics and behavioural patterns of men who have sex with men.” The authors call for the government step-up leadership in the HIV response at both national and regional level to ensure the epidemic does not spread among the general population.