Pattern and its associated risk factors among male STD clinic attendees in China : An focientry-point for HIV intervention

Background Previous studies suggested a high prevalence of STDIs including HIV among female sex workers and men who have sex with men in China but little was known about the scale in male patients attending public STD clinics. This aim of this study was to investigate STD patterns and HIV prevalence among male STD clinic attendees in different areas in China and the associated risk factors. Feasibility of PITC was evaluated as well. Methods A cross-sectional study was conducted at 46 public STD clinics in 4 provinces in China. Between July 2009 and September 2009, a total of 3243 eligible subjects were invited to participate in an interview with a structured-questionnaire for collecting socio-demographic characteristics and sexual behavioral information, and provide venous blood for serological determinations of HIV and syphilis infection and first void urine specimens for detecting Chlamydia trachomatis and Neisseria gonorrhoeae infections using a nucleic acid amplification assay. Results Out of the 3243 eligible patients, 2951(91%) agreed to take part in the HIV and syphilis testing. Forty-six percent of the patients had visited female sex worker (FSW) and 25.7% had non-FSW casual sexual partner(s) in the last three months. Condom use rate was low in this population. Only 6.2% had ever received HIV testing and counseling and knew their HIV status. The overall prevalence rate of HIV infection was 0.7% while the rates of syphilis, N. gonorrhoeae, C. trachomatis infections were 10.7% , 4.3% and 6.9%, respectively, with highest in Jiangsu Province. Patients from Guangxi province, homosexual/bisexual and IDUs were significantly associated with HIV infection in multivariate logistic regression. Provider-initiated HIV testing and counseling (PITC) was well accepted by attendees, 91% of eligible attendees agree to undergo HIV testing and counseling. All HIV positive persons were properly managed accordingly. Conclusion A modest prevalence of HIV and substantial prevalence of other STDIs were found among male patients attending public STD clinics in China. The findings further support the introduction of HIV and syphilis PITC strategy into this important setting. Background Sexually Transmitted Diseases (STDs) are a group of communicable diseases that are transmitted predominantly via sexual contact and caused by different etiologies. STDs were nearly eliminated in the 1960s in China. The situation changed rapidly with the initiation of economic reform in the 1980s, STDs again became a major public health problem. In 2005, a total of 703 001 new STD cases ( including gonorrhoea, syphilis, non-gonococcal urethritis, genital herpes, genital warts, chancroid and lymphogranuloma venereum) were reported. Reported syphilis cases increased sharply from 88311 in 2004 to 358534 in 2010. Interestingly, reported gonorrhoea cases decreased significantly from 228294 in 2004 to 105544 in 2010 (unpublished data from National Center for STD Control, China CDC). STD screening is fundamental useful to decrease HIV transmission because it allows identification of patients with ongoing high risk sexual behavior and enables the treatment of STDs, which facilitate the transmission of HIV infection . ReportedLimited epidemiological studies showed varied STD/HIV prevalence among STD clinic attendees in China, with HIV ranged from 0% to12.6% , Chlamydia trachomatis from 6.3 % to 30.3 %, gonorrhoea from 4.1 % to 17.3 % and syphilis from 9.1% to 23.2 %. and nNone of these studies pertaining to using identical laboratory methods to evaluate STDs in different areas in China. The difference may result from varying sampling strategies and diagnostic capacities, but is also very likely to reflect local endemic conditions in different geographic areas. Further understanding of STD/HIV prevailing in different regions in China using identical sampling and laboratory methods is necessary for proper planning and implementation of STD/HIV control strategies. The first acquired immunodeficiency syndrome (AIDS) case in China was reported in June 1985. The epidemic has entered a wide spreading phase now. Historically, the majority of reported HIV infections in China are acquired through injecting drug use and commercial blood/plasma collection. Sexually transmitted HIV cases have steadily increased and comprised more than half the reported HIV/AIDS infections since 2007. [17-18] Heterosexually transmitted HIV accounted for 47.1% while homosexually transmitted HIV accounted for 8.6% of the reported HIV cases in 2009. In China, as many as 57 % of HIV-infected adults were estimated to be unaware of their serostatus in 2009. “Too little, too late” is the current China HIV testing status in China. Although the Chinese government has initiated a widespread massscreening program to enhance case finding, this is not linked to any existing system of clinical care. Clientinitiated voluntary counselling and testing (VCT) has been effective in identifying substantial numbers of HIV-positive individuals. However, the coverage remains low for many reasons including low perception of personal HIV risk, fear of stigma and discrimination. A newer approach to knowledge of HIV status through routine opt-out provider-initiated HIV testing and counseling (PITC) services has been recommended. In routine opt-out PITC, HIV testing and counselling are recommended as standard components of medical care at healthcare facilities. One barrier to testing worldwide has been stigma, an issues that have been increasingly acknowledged in the Chinese response to HIV. The term “opt-out” means that patients must explicitly refuse an HIV test. In this way PITC can help to overcome stigma and could enable more patients to rapidly know their HIV status. In settings where high-risk patients await health care services, such as an STD clinic,failure to implement PITC is a missed opportunity for patients to benefit from counseling, prevention, early diagnosis, and referral into care and treatment for HIV infection. Currently there are debates on whether PITC is needed among STD clinics in China. Moreover, the acceptance of PITC by both providers and patients remains unknown. This aim of this study was to investigate STD patterns and HIV prevalence among STD clinic attendees in different areas in China and the associated risk factors. Feasibility of PITC was evaluated as well.