Sexual Behaviors and HIV/Syphilis Testing Among Transgender Individuals in China

Best, John; Tang, Weiming; Zhang, Ye; Han, Larry; Liu, Fengying; Huang, Shujie; Yang, Bin; Wei, Chongyi; Tucker, Joseph D.

doi:10.1097/olq.0000000000000269

Cited by 39 publications

(38 citation statements)

References 25 publications

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“…Second, lack of screening and poor service delivery have contributed to the epidemic. For example, one survey from 2013 revealed that only about 30% men who have sex with men (MSM) reported ever having tested for syphilis, despite a syphilis prevalence of 9%13. Limited screening and other related services may miss a large number of syphilis patients that need to be diagnosed and treated, resulting in a larger proportion of preventable early syphilis cases progressing to neurosyphilis or other types of tertiary syphilis.…”

Section: Discussionmentioning

confidence: 99%

Late Neurosyphilis and Tertiary Syphilis in Guangdong Province, China: Results from a Cross-sectional Study

Tang

Huang

Chen

et al. 2017

Sci Rep

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Due to challenges in diagnosis and the need for complex laboratory tests, misdiagnosis of neurosyphilis and tertiary syphilis is common in China. We validated the diagnosis and examined the treatment of late neurosyphilis and tertiary syphilis in Guangdong Province, China. A cross-sectional study was conducted to collect data from late neurosyphilis and tertiary syphilis cases reported between 2009 and 2014 in Guangdong, China. Descriptive analysis, bivariate analyses and multiple logistic regressions were performed to determine the structural factors associated with correct diagnosis and standard treatment of late neurosyphilis and tertiary syphilis. Among the 3805 respondents (3805/3936, 96.7%), 1,837 (48.3%) met the misdiagnosed criteria. The misdiagnosis rate decreased over the study period (54.2% in 2009 and 41.8% in 2014). Only 27.1% and 24.9% of the correctly diagnosed late neurosyphilis and tertiary syphilis cases received standard treatment, respectively. Multiple logistic regression revealed that departments of dermatology or STDs [aOR = 3.24, 95% CI: 2.66–3.95], county or township level hospitals [aOR = 2.89, 95% CI: 2.14–3.89], and hospitals situated outside of Pearl River Delta area [aOR = 1.70, 95% CI: 1.46–1.97] had higher likelihood in misdiagnosis of neurosyphilis, compared to the reference groups. Targeted trainings for physicians and expanded syphilis screening services are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Late Neurosyphilis and Tertiary Syphilis in Guangdong Province, China: Results from a Cross-sectional Study

Tang

Huang

Chen

et al. 2017

Sci Rep

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“…In China, the government has significantly expanded surveillance efforts among MSM in response to the rapid spread of HIV in this key population [9]. Yet, several systematic reviews suggest that still only half of MSM have ever tested for HIV [10][11][12]. In addition, syphilis test uptake is poor in China [11], which is concerning given the rise in HIV and syphilis co-infections among Chinese MSM [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Yet, several systematic reviews suggest that still only half of MSM have ever tested for HIV [10][11][12]. In addition, syphilis test uptake is poor in China [11], which is concerning given the rise in HIV and syphilis co-infections among Chinese MSM [13,14]. The Chinese Centers for Disease Control and Prevention (CDC) offer free HIV testing at voluntary counselling and testing sites [15].…”

Section: Introductionmentioning

confidence: 99%

Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross‐sectional online survey

Zhang

Liu

Han

et al. 2017

Journal of the International AIDS Society

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Introduction: HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China.Methods: MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing.Results: 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98–12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16–9.04).Conclusions: HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.

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“…11 There is limited data on the burden of HIV and HIV-related risk behaviours among Chinese TG individuals. The only paper focused on this Chinese demographic reported elevated risk of HIV infection compared with MSM; 12 however, the specific risk factors are still unknown. Additional research is needed to characterise the demographics, behaviours and preferences on TG individuals in China.…”

Section: Introductionmentioning

confidence: 99%

Transgender sexual health in China: a cross-sectional online survey in China

Zhang¹,

Best

Tang³

et al. 2016

Sex Transm Infect

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Objective Transgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men who have sex with men (MSM) and transgender individuals to examine sociodemographics, intimate partner violence (IPV) and sexual behaviours in China. Methods We recruited participants (born biologically male, ≥16 years old, ever engaged in anal sex with men and agreed to provide cell phone number) from three web platforms in 2014. Data on sociodemographics, IPV and sexual behaviours were collected. Logistic regressions were performed to compare the differences between transgender individuals and non-transgender MSM. Results Overall, 1424 eligible participants completed our online survey. Of these participants, 61 (4.3%) were transgender individuals, including 28 (2.0%) identifying as women and 33 (2.3%) identifying as transgender. Compared with MSM, transgender individuals were more likely to have experienced IPV and sexual violence (economic abuse, physical abuse, threat to harm loved ones, threat to ‘out’, forced sex). In addition, transgender individuals were more likely to have engaged in commercial sex (21.3% vs 5.1%, aOR 4.80, 95% CI 2.43 to 9.51) and group sex (26.2% vs 9.2%, aOR 3.47, 95% CI 1.58 to 6.48) in the last 12 months. Conclusions Our study is consistent with the emerging literature demonstrating increased sexual risk behaviours and high levels of IPV among transgender individuals. Future research should further investigate transgender individuals’ experiences of IPV and explore ways to promote disclosure of gender identity to healthcare providers. Furthermore, transgender research in China should be expanded independently of MSM research.

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Sexual Behaviors and HIV/Syphilis Testing Among Transgender Individuals in China

Cited by 39 publications

References 25 publications

Late Neurosyphilis and Tertiary Syphilis in Guangdong Province, China: Results from a Cross-sectional Study

Late Neurosyphilis and Tertiary Syphilis in Guangdong Province, China: Results from a Cross-sectional Study

Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross‐sectional online survey

Transgender sexual health in China: a cross-sectional online survey in China

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