Objective To understand the prevalence of HIV infection,syphilis and hepatitis C infection and related risk behaviors among club drug users in Zhejiang province.Methods The drug users were interviewed with questionnaires in 2011 to collect the information about their demographic characteristics,sexual behaviors,drug use behaviors and the utilization of intervention services.Blood samples were collected from them to detect HIV,syphilis and HCV antibodies.Results A total of 3 253 drug users were surveyed,in which 1 298 were club drug users,accounted for 39.9％.The proportion of club drug users was high in northern and central Zhejiang,in females,in age group ≤25 years,in local residents and in those having commercial sexual behaviors during previous 12 months.Of the 1 298 club drug users,91.2％ were methamphetamine users,0.1％ were infected with HIV(95％CI:0.0％-0.2％),8.1％ suffered from syphilis (95％CI:6.6％-9.6％),17.3％ were infected with HCV(95％CI:15.2％-19.4％).Among the interviewed club drug users,12.7％ were aware of AIDS,9.2％ had injecting drug use histories,29.6％ reported having commercial sex during the previous 12 months,only 33.4％ received free condom and counsel,14.0％ received HIV test.Multivariate logistic regression analysis indicated that living in central and southern Zhejiang was associated with syphilis prevalence,HCV infection and injecting drug use behavior,being female was associated with syphilis prevalence.Injecting drug use and commercial sex during the previous 12 months were associated with HCV infection,and injecting drug use and commercial sex during the previous 12 months were associated with each other.Among the 1 285 club drug users,males,local residents in Zhejiang and those who never received free condom or counsel were more likely to have commercial sex.Conclusion The prevalence of syphilis and HCV infection are high and unprotected sexual behaviors are common among the club drug users in Zhejiang,but less intervention services were received by them,suggesting that more attention should be paid to the prevention and control of HIV,HCV infections and syphilis in club drug users by taking effective intervention measures and increasing intervention coverage.

Objective: To analyze the epidemiological characteristics of newly diagnosed HIV/AIDS cases aged 50 years or over in Zhejiang Province from 2015 to 2019, so as to provide reference for the development of prevention and control strategies. Methods : The data of newly diagnosed HIV/AIDS cases in Zhejiang Province were collected through the China HIV/AIDS Comprehensive Response Information Management System, and the demographic characteristics, infection routes,regional distribution and time distribution of the cases were analyzed. Results: A total of 6 726 HIV/AIDS patients were recruited in this study, and the number of new patients from 2015 to 2019 showed an increasing trend ( P <0.05 ) . The number of participants diagnosed at the age of 50-59, 60-69 and 70-91 years old were 3 433( 51.04% ), 2 242 ( 33.33% ) and 1 051 ( 15.63% ). The majority of them were males ( 5 180, 77.01% ) , married ( 4 286, 63.72% ) , Zhejiang residents ( 5 304, 78.86% ) , and lived in rural areas ( 4 095, 60.88% ) . In terms of exposure history,6 586 cases ( 97.92% ) were infected by sexual contact. Among the 5 083 males infected by sexual contact, 82.63% were through heterosexual contact, 94.79% had extramarital sex partners, among whom 76.61% were commercial sex partners. The married women patients who confirmed HIV positive accounted for 75.44%. There were increasing trends in the proportion of the cases living in rural areas, male cases infected through heterosexual contact and those with extramarital and commercial sex partners, and female cases with their husbands positive along with age ( P <0.05 ) . Conclusions The number of newly diagnosed HIV/AIDS cases aged ≥50 years is increasing in Zhejiang Province. Many of them live in rural areas. Commercial sexual contact is the main route of HIV transmission among males and further lead to HIV transmission within couples.

Objective: To understand the molecular subtypes and recombinant structure of HIV-1 infection in Zhejiang Province. Methods: According to the method of stratified random sampling method, a total of 302 newly HIV infected people (excluding AIDS patients) were selected as the subjects of the investigation from April to June, 2015, who were all newly HIV positive patients reported in Zhejiang Province and were diagnosed as HIV positive and had not received antiretroviral treatment. Questionnaires were used to collect information such as gender, residency, marital status, route of transmission and case reporting area. At least 8 ml of venous blood was collected from HIV infected people, reverse transcription-polymerase chain reaction (RT-PCR) and nested PCR were used to amplify the pol gene sequence of HIV-1 strains and circulating recombination forms (CRF) and unique recombinant form (URF) strains were screened using phylogenetic tree, and molecular subtype analysis and recombinant analysis were performed. Results: Of the 302 HIV infected people, 18 cases were infected with new CRFs or URFs, among which 15 were male (83.3%), 3 were heterosexual transmission (17.7%); 8 cases (44.4%) were infected with new CRFs, which included CRF55_01B 5(27.8%), CRF67_01B 2 (11.1%), CRF69_01B 1 (5.6%); 10 cases (55.6%) were infected with URFs, in which 6 cases were infected with two groups of recombinant strains composed of CRF01_AE subtype and CRF07_BC subtypes in pol region, 3 cases were infected with three groups of recombinant strains of the two subtypes in pol region, and 1 case could not be accurately determined of the recombinant structure. The results of recombinant source analysis showed that the newly recombinant strains found from Zhejiang province were highly homologous to the strains from Guangdong, Anhui, Hebei, Yunnan, Liaoning province, and the sequence similarity was 94.4%-98.0%. Conclusion The new recombinant strains of Zhejiang province included CRFs strains and URFs strains with CRF01_AE and CRF07_BC as the main recombinant structure mode, and all of them were introduced from other places and formed a trans-regional chain of HIV transmission.

OBJECTIVETo identify the status and risk factors of transmission in couples which males was HIV-positive in Zhejiang province.

METHODSA cross-sectional study was conducted among HIV-serodiscordant couple (male positive) and HIV-seroconcordant couple (male first infected). A self-designed questionnaire was complimented containing basic information, the awareness of infection and HIV-testing, sexual relationship power, self-efficacy of condom use, sex. The univariated and multivariate logistic regression methods were used to analyze the influence factors.

RESULTSA total of 263 couples were enrolled in this study, including 210 HIV HIV-serodiscordant couples and 53 HIV-seroconcordant couples. HIV-positive males aged 30-50 accounted for 57.8% (152 cases) and females under junior high school accounted for 79.1% (208 cases). HIV/AIDS accounted for 41.1% (217 cases). The proportion of man who were diagnosed as HIV, MSM and ever heard HIV were 61.9% (130 cases), 38.3% (80 cases) and 81.9% (172 cases), which were higher than that in HIV positive 47.2% (25 cases), 7.5% (4 cases), 64.2% (34 cases); χ(2)=3.80, 18.33, 7.86;P=0.051, 0.001, 0.005. The results revealed that AIDS patients had high risk to infect their spouse than HIV patients (OR=2.93, 95% CI: 1.05-8.21). Male patients who had ever heard " HIV" before were less likely pass virus to their wives than those who had never heard " HIV" (OR=0.13, 95% CI: 0.04-0.41). Compared with heterosexuality man, homosexuality man' wives had high risk to get virus from their husbands (OR=0.14, 95% CI: 0.03-0.73). Female infected with STIs was the independent factors for HIV infection (OR=4.86, 95% CI: 1.23-19.11).

CONCLUSIONAmong the couples of male HIV-positive in Zhejiang Province, the risk of spouses infected with HIV virus has relationship with male disease progression, sexual orientation and awareness of AIDS knowledge. For females who infected with sexual diseases in last 6 months might be infected by their spouses.

Adult ; Cross-Sectional Studies ; Female ; HIV Antibodies ; blood ; HIV Infections ; transmission ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Mass Screening ; Middle Aged ; Risk Factors ; Sexual Behavior ; Sexually Transmitted Diseases ; transmission ; Spouses

Objective To understand the distribution of HIV-1 subtype diversity and its transmission characteristics in Zhejiang province. Methods A total of 302 newly diagnosed HIV-1 positive patients were selected through stratified random sampling in Zhejiang in 2015. HIV-1 pol genes were sequenced successfully with reverse transcription PCR/nested PCR and phylogenetic analysis was conducted for 276 patients. Then a molecular epidemiologic study was performed combined with field epidemiological investigation. Results Of 276 sequence samples analyzed, 122 CRF07_BC strains (44.2%), 103 CRF01_AE strains (37.3%), 17 CRF08_BC strains (6.1%), 9 B strains (3.2%), 6 CRF55_01B strains (2.2%), 5 C strains (1.8%), 1 CRF59_01B strain (0.4%), 1 CRF67_01B strain (0.4%), 1 A1 strain (0.4%), and 11 URFs strains (4.0%) were identified. Phylogenetic analysis revealed 16 clusters with only 15.1% (34/225) sequences involved among CRF07_BC and CRF01_AE strains. The clustered cases in MSM were higher than that in populations with other transmission routes. And clusters existed between the populations with different transmission routes. Conclusion The major strains of HIV-1 in Zhejiang are CRF07_BC and CRF01_AE. The HIV subtypes showed more complexity in Zhejiang. It is necessary to strengthen the surveillance for HIV subtypes, carry out classified management and conduct effective prevention and control in the population at high risk.

Objective To understand the characteristics of distribution on HIV-1 subtypes and the transmission clusters in Yiwu in Zhejiang province.Methods A cross-sectional study of molecular epidemiology was carried out on newly reported H1V/AIDS cases in Yiwu.RNA was extracted from 168 plasma samples,followed by RT-PCR and nest-PCR for pol gene amplification,sequencing,phylogenetic tree construction used for analyzing the subtypes and transmission clusters.Mutations on drug resistance was analyzed by CPR 6.0 online tool.Results Subjects were mainly males (86.3％,145/168),with average age as (39.1 ± 13.4) years old and most of them were migrants (66.7％,112/168).The major routes of transmission included homosexual (51.2％,86/168) and heterosexual (48.8％,82/168) contacts.The rate of success for sequence acquisition was 89.9％ (151/168).The dominant subtypes showed as CRF01_AE (74,49.0％) and CRF07_BC (64,42.4％),followed by CRF08_BC (5,3.3％),CRF55_01B (3,2.0％),each case of subtype B,CRF45_cpx,CRF59_01B,CRF85_BC and URF (B/C).CRF45_cpx and CRF85_BC were discovered the first time in Zhejiang province.Twenty-six transmission clusters involving 65 cases were found,with the total clustered rate as 43.0％ (65/151),in which the CRF01_AE clustered rate appeared as 54.1％ (40/74),higher than that of CRF07_BC (21/64,32.8％).The average size of cluster was 2.5 cases/cluster,with average size of cluster in CRF01_AE patients infected through heterosexual transmission as the largest (3.5 cases/cluster).The prevalence of transmitted drug resistance was 4.6％ (7/151).Seven cases with surveillance drug resistant mutations (SDRM) were found,including 5 cases of M46L (3.3％),and one case of F77L or Y181C.Conclusion HIV genetic diversity and a variety of transmission clusters had been noticed in this study area (Yiwu).Programs on monitoring the subtypes and transmission clusters should be continued and strengthened.

Objective To identify the HIV transmission in discordant couples and the epidemic characteristics of concordant couples related to HIV infection.Methods HIV/AIDS database was down-loaded from AIDS information reported system for analysis.Patients with HIV-negative couples between 2009 and 2013 in Zhejiang province were enrolled in this study.Information included demography characteristics,highly active antiretroviral therapy (HAART),HIV incidence rate and risk factors,characteristics on HIV concordant couples.Results The HIV incidence rate on HIV-negative couples of 2 575 HIV/AIDS was 3.56 per 1 000 person-year,reducing from 5.49 per 1 000 person-year in 2009 to 3.20 per 1 000 person-year in 2013.There was a slight increase on HIV incidence rate among couples in those HIV-positive men who were heterosexual,while it decreased among couples of HIV-positive women.Initiation of HAART over 1 years (OR=0.063,95％ CI:0.019-0.204) seemed to be a preventive factor for HIV transmission between the couples under study.Factors as history of infection longer than 3 years (OR=3.564,95％ CI:1.296-9.804) and beingnon-local resident (OR=2.626,95％ CI:1.098-6.230) were risky factors.Conclusion The incidence rate of HIV transmission between HIV discordant couples was low but imbalance in different areas.People who were non-local residents under HIV discordant status,would need more attention.HAART,time of infection,status of residency appeared risk factors for HIV transmission within the couples.

Objective: To evaluate the third round of Zhejiang Comprehensive AIDS Response (CARES) program (nine national areas and three provincial areas) and the control effect of AIDS, so as to provide reference for AIDS prevention and control. Methods: According to the final assessment protocol of the third round of China CARES, the data of 23 assessment items which were collected from online database and field investigation for 12 response areas of Zhejiang in 2014 and 2018 were evaluated. The endemic situation and detection of AIDS in CARES areas was compared with those in non-CARES areas, in order to evaluate the achievement of Zhejiang CARES areas. Results: The rates of reaching the standard ranged from 91.30% to 100.00% in 12 CARES areas. Six indexes in leadership and innovation, fifteen (seventeen in total) indexes in HIV/AIDS control and prevention reached the standard. The items that failed included the awareness rates of AIDS and indicators in “prevention and intervention”. The rates of of reaching the standard in “publicity and education”, “monitoring and testing”, “prevention and intervention”, and “treatment and follow-up” increased from 55.56%, 79.17%, 79.76% and 65.00% in 2014 to 91.67%, 100.00%, 90.48% and 100.00% in 2018, respectively. The proportion of HIV testing people in permanent residents was 30.94% in CARES areas in 2018, which was significantly higher than 20.70% in non-CARES areas (P<0.05). The proportion of new reported HIV/AIDS in CARES areas was 50.87%, and the average increase was 4.48%, which was lower than 9.95% in non-CARES areas. Conclusion The third round of Zhejiang CARES program has remarkable achievement and plays a positive role in the prevention and control of AIDS.