China's HIV epidemic may be shifting towards predominantly sexual transmission and emerging data point to potential increases in HIV prevalence among men who have sex with men (MSM). There is particular need to assess the extent of risk behavior among MSM outside of China's most cosmopolitan cities. We conducted a respondent-driven sampling survey (N = 428) to measure HIV seroprevalence and risk behavior among MSM in Jinan, China, the provincial capital of Shandong. HIV prevalence was 0.5% (95% confidence interval [CI] 0.1-1.0). Unprotected anal intercourse (UAI) in the last 6 months (reported by 61.4%) was associated with buying or selling sex to a man in the last 6 months, syphilis infection, multiple partners in the last month, low HIV knowledge and migrant status. No participant had previously tested for HIV. Risk for HIV transmission is widespread among MSM throughout China; basic prevention programs are urgently needed.

We report on two waves of bio-behavioral surveillance of MSM in Jinan, Shandong Province, China. HIV prevalence rose from 0.05% in 2007 to 3.1% in 2008. Differences in the two waves of surveys were noted, particularly with respect to marital status, requiring stratified analysis. In multivariable analysis, unmarried, homosexually identified MSM who do not have female sex partners have a greater than sixfold greater chance of being infected with HIV compared to married, non-homosexually identified MSM who do have female partners. Carefully targeted and population-specific messages will be needed for homosexually identified and non-identified MSM in China.

BackgroundFemale commercial sex workers (FSWs) are at high risk of human immunodeficiency virus (HIV) transmission in China. This study was designed to examine the predictors of condom use with clients during vaginal intercourse among FSWs based on the Information-Motivation-Behavioral Skills (IMB) model and to describe the relationships between IMB model constructs.MethodsA cross-sectional study was conducted in Jinan of Shandong Province, from May to October, 2009. Participants (N = 432) were recruited using Respondent-Driven Sampling (RDS). A self-administered questionnaire was used to collect data. Structural equation modeling was used to assess the IMB model.ResultsA total of 427 (98.8%) participants completed their questionnaires. Condom use was significantly predicted by social referents support, experiences with and attitudes toward condoms, self-efficacy, and health behaviors and condom use skills. Significant indirect predictors of condom use mediated through behavioral skills included HIV knowledge, social referents support, and substance use.ConclusionsThese results suggest that the IMB model could be used to predict condom use among Chinese FSWs. Further research is warranted to develop preventive interventions on the basis of the IMB model to promote condom use among FSWs in China.

China has made great efforts in air pollution control since 2013. However, there is a lack of evaluation of environmental, health and economic co-benefits associated with the national and local air pollution control measures at a city level. We analyzed local air pollution control policies and implementation in Jinan, one of the most heavily air-polluted cities in China between 2013 and 2017. We assessed the changes in exhaust emissions, air quality, mortality and morbidity of associated specific-diseases, and related economic benefits. We also projected the future scenarios of PM 2.5 concentration dropped to 15 μg/m 3. There were significant decreases in exhaust emissions of SO 2 and no x in Jinan during the study period. Annual reductions in ambient air pollution were 72.6% for SO 2 , 43.1% for PM 2.5 , and 34.2% for PM 10. A total of 2,317 (95%CI: 1,533-2,842) premature deaths and 15,822 (95%CI: 8,734-23,990) related morbidity cases had been avoided in 2017, leading to a total of US$ 317.7 million (95%CI: 227.5-458.1) in economic benefits. Decreasing PM 2.5 concentrations to 15 μg/m 3 would result in reductions of 70% in total PM 2.5-related non-accidental mortality and 95% in total PM 2.5-related morbidity, which translates into US$ 1,289.5 million (95%CI: 825.8-1,673.6) in economic benefits. The national and local air pollution control measures have brought significant environmental, health and economic benefits to a previously heavy polluted Chinese city. Air pollution is a major global health concern, especially in developing countries like China. In January 2013, a severe air pollution event affected one-third of the major cities in China 1. Since then, air pollution, especially the risks from PM 2.5 (particle matter with aerodynamic diameter ≤ 2.5 μm), has become a growing concern in China 2,3. Spatial and temporal distributions of air quality in China show that winter months in northern cities are the most polluted because of coal burning and other fossil fuel combustion for heating 4-7. Scientific studies have provided strong evidence on the effects of PM 2.5 on mortality and morbidity, and for both short-term and long-term exposures 8,9. In May 2018, the World Health Organization (WHO) reported that 4.2 million deaths occur annually as a result of exposure to ambient air pollution globally with developing countries having the highest burden 10. The first WHO Global Conference on Air Pollution and Health held in November 2018 emphasized an aspirational goal of reducing the number of deaths from air pollution by two-thirds by 2030 and the urgent need for bold and prompt actions to address the present health crisis caused by air pollution 11. In order to improve air quality and to protect human health, the Chinese government has implemented a series of national policies to reduce the emissions of air pollutants after the 2013 national severe air pollution event 4,12. In September 2013, the State Council of China issued the Air Pollution Prevention and Control Action Plan (APPCAP), which comprises ten spe...

Targeted, culturally appropriate and innovative interventions to increase HIV testing uptake should be a top priority for HIV prevention among MSM in China.

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The China Healthy Cities initiative, a nationwide public health campaign, has been implemented for 25 years. As "Healthy China 2030" becomes the key national strategy for improving population health, this initiative is an important component. However, the effects of the initiative have not been well studied. This paper aims to explore its impact on urban environment using a multiple time series design. We adopted a stratified and systematic sampling method to choose 15 China healthy cities across the country. For the selected healthy cities, 1:1 matched non-healthy cities were selected as the comparison group. We collected longitudinal data from 5 years before cities achieved the healthy city title up to 2012. We used hierarchical models to calculate difference-in-differences estimates for examining the impact of the initiative. We found that the China Healthy Cities initiative was associated with increases in the proportion of urban domestic sewage treated (32 percentage points), the proportion of urban domestic garbage treated (30 percentage points), and the proportion of qualified farmers' markets (40 percentage points), all of which are statistically significant (P < 0.05). No significant change was found for increases in green coverage of urban built-up area (5 percentage points), green space per capita (2 square meter), and days with Air Quality Index/Air Pollution Index ≤ 100 (25 days). In conclusion, the China Healthy Cities initiative was associated with significant improved urban environment in terms of infrastructure construction, yet had little impact on green space and air quality.

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