OBJECTIVETo understand the high risk behaviors of female sex workers (FSWs) in Yunnan province in 2013.

METHODSA cross-sectional investigation was conducted during April to June, 2013 in Yunnan province, census was used to the investigation where the number of FSWs was close to 200, while probability sampling was used where the number of FSWs was obviously over 200. A total of 25 574 cases were investigated, and data on demography and risk behaviors were obtained by questionnaires one by one.

RESULTSA total of 25 574 cases were investigated, AIDS awareness among FSWs in high-level places, middle-level places and low-level place were 98.8% (92/7 401), 98.6% (150/10 995), and 96.0% (281/6 655). FSWs from low-level place had a lower rate than those from the other two types of places (P < 0.01). The rate of condom use each time when having sex with clients within the recent one month among FESs from high-level places, middle-level places and low-level place were 93.4% (6 307/6 755), 93.8% (10 109/10 782) and 90.4% (6 053/6 697), and the FSWs working in low-level place had a lower rate than those from the other two types of places(P < 0.01). Multi-factor logistic regression analysis showed that the following had a lower rate of condom use: the FSWs working in low-level place (OR = 1.56, 95% CI:1.36-1.79; OR = 1.36, 1.16-1.59), over 30 years old (OR = 0.77, 95%CI:0.69-0.85), Yunnan citizen (OR = 0.88, 95% CI:0.77-1.00), minority (OR = 1.32, 95% CI:1.16-1.50), under senior high school (OR = 0.61, 95%CI:0.49-0.75), married (OR = 0.81, 95% CI:0.71-0.92), living together (OR = 0.70, 95% CI:0.51-0.96), divorced or lost spouses (OR = 0.81, 95% CI:0.65-1.02), worked less than 6 months in local areas (OR = 1.74, 95% CI:1.34-2.27), drug users (OR = 1.65, 95% CI:1.11-2.46), had not accepted HIV interventions (OR = 2.91, 95% CI:2.36-3.58), had no knowledge about AIDS (OR = 4.50, 95% CI:3.48-5.82). The main reasons for not using condoms were the clients' unwilling to use, which accounted for 47.62% (270/567). The total rate of drug use was 1.0% (264/25 567) and the FSWs working in middle-level places had the highest rate of injecting drugs, which accounted for 0.6% (70/11 141). The FSWs working in low-level places had a higher rate than those who worked in high-level places and middle-level places in venereal diseases, which accounted for 1.2% (85/6 934) (P < 0.01). The rate of receiving effective interventions was 96.7% (24 717/25 574), the rate of accepting treatment and clean needles among drug users was 21.6% (57/264).

CONCLUSIONHigh risk behaviors were serious among the FSWs who worked in low-level places, especially among the olders, the minorities, people who had lower educational level, the new-comer and drug users, which indicated that more attention needs to be paid among these populations.

Age Factors ; China ; Condoms ; Cross-Sectional Studies ; Demography ; Drug Users ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Marital Status ; Risk-Taking ; Safe Sex ; Sex Workers ; Sexually Transmitted Diseases ; Socioeconomic Factors ; Surveys and Questionnaires

Objective To understand the high risk behaviors of female sex workers ( FSWs) in Yunnan province in 2013.Methods A cross-sectional investigation was conducted during April to June, 2013 in Yunnan province, census was used to the investigation where the number of FSWs was close to 200, while probability sampling was used where the number of FSWs was obviously over 200.A total of 25 574 cases were investigated, and data on demography and risk behaviors were obtained by questionnaires one by one.Results A total of 25 574 cases were investigated, AIDS awareness among FSWs in high-level places, middle-level places and low-level place were 98.8%( 92/7 401 ) , 98.6%( 150/10 995 ) , and 96.0%(281/6 655).FSWs from low-level place had a lower rate than those from the other two types of places(P<0.01).The rate of condom use each time when having sex with clients within the recent one month among FESs from high-level places, middle-level places and low-level place were 93.4%(6 307/6 755), 93.8%(10 109/10 782) and 90.4%(6 053/6 697), and the FSWs working in low-level place had a lower rate than those from the other two types of places(P<0.01).Multi-factor logistic regression analysis showed that the following had a lower rate of condom use: the FSWs working in low-level place(OR=1.56,95%CI:1.36-1.79;OR=1.36,1.16-1.59), over 30 years old(OR=0.77, 95%CI:0.69-0.85), Yunnan citizen (OR=0.88, 95%CI:0.77-1.00), minority(OR=1.32, 95%CI:1.16-1.50), under senior high school (OR=0.61, 95%CI:0.49-0.75),married(OR=0.81,95%CI:0.71-0.92), living together(OR=0.70, 95%CI:0.51-0.96), divorced or lost spouses(OR=0.81,95%CI:0.65-1.02), worked less than 6 months in local areas(OR=1.74, 95%CI:1.34-2.27), drug users(OR=1.65, 95%CI:1.11-2.46), had not accepted HIV interventions(OR=2.91,95%CI:2.36-3.58), had no knowledge about AIDS(OR=4.50, 95%CI:3.48-5.82 ) .The main reasons for not using condoms were the clients′unwilling to use, which accounted for 47.62%( 270/567 ) .The total rate of drug use was 1.0%( 264/25 567 ) and the FSWs working in middle-level places had the highest rate of injecting drugs, which accounted for 0.6%( 70/11 141).The FSWs working in low-level places had a higher rate than those who worked in high-level places and middle-level places in venereal diseases, which accounted for 1.2%(85/6 934)(P<0.01).The rate of receiving effective interventions was 96.7%(24 717/25 574), the rate of accepting treatment and clean needles among drug users was 21.6%(57/264).Conclusion High risk behaviors were serious among the FSWs who worked in low-level places, especially among the olders, the minorities, people who had lower educational level, the new-comer and drug users, which indicated that more attention needs to be paid among these populations.

Objective To understand the high risk behaviors of female sex workers ( FSWs) in Yunnan province in 2013.Methods A cross-sectional investigation was conducted during April to June, 2013 in Yunnan province, census was used to the investigation where the number of FSWs was close to 200, while probability sampling was used where the number of FSWs was obviously over 200.A total of 25 574 cases were investigated, and data on demography and risk behaviors were obtained by questionnaires one by one.Results A total of 25 574 cases were investigated, AIDS awareness among FSWs in high-level places, middle-level places and low-level place were 98.8%( 92/7 401 ) , 98.6%( 150/10 995 ) , and 96.0%(281/6 655).FSWs from low-level place had a lower rate than those from the other two types of places(P<0.01).The rate of condom use each time when having sex with clients within the recent one month among FESs from high-level places, middle-level places and low-level place were 93.4%(6 307/6 755), 93.8%(10 109/10 782) and 90.4%(6 053/6 697), and the FSWs working in low-level place had a lower rate than those from the other two types of places(P<0.01).Multi-factor logistic regression analysis showed that the following had a lower rate of condom use: the FSWs working in low-level place(OR=1.56,95%CI:1.36-1.79;OR=1.36,1.16-1.59), over 30 years old(OR=0.77, 95%CI:0.69-0.85), Yunnan citizen (OR=0.88, 95%CI:0.77-1.00), minority(OR=1.32, 95%CI:1.16-1.50), under senior high school (OR=0.61, 95%CI:0.49-0.75),married(OR=0.81,95%CI:0.71-0.92), living together(OR=0.70, 95%CI:0.51-0.96), divorced or lost spouses(OR=0.81,95%CI:0.65-1.02), worked less than 6 months in local areas(OR=1.74, 95%CI:1.34-2.27), drug users(OR=1.65, 95%CI:1.11-2.46), had not accepted HIV interventions(OR=2.91,95%CI:2.36-3.58), had no knowledge about AIDS(OR=4.50, 95%CI:3.48-5.82 ) .The main reasons for not using condoms were the clients′unwilling to use, which accounted for 47.62%( 270/567 ) .The total rate of drug use was 1.0%( 264/25 567 ) and the FSWs working in middle-level places had the highest rate of injecting drugs, which accounted for 0.6%( 70/11 141).The FSWs working in low-level places had a higher rate than those who worked in high-level places and middle-level places in venereal diseases, which accounted for 1.2%(85/6 934)(P<0.01).The rate of receiving effective interventions was 96.7%(24 717/25 574), the rate of accepting treatment and clean needles among drug users was 21.6%(57/264).Conclusion High risk behaviors were serious among the FSWs who worked in low-level places, especially among the olders, the minorities, people who had lower educational level, the new-comer and drug users, which indicated that more attention needs to be paid among these populations.

Objective To understand HIV incidence in community residents and epidemiological characteristics of newly detected HIV infection cases in Dali,Yunnan province.Methods A cohort study was conducted among 146720 community residents who were tested to be HIV negative during 2010-2011,they were followed-up from June 1,2014 to May 31,2015.Results A total of 136356 community residents received follow up (92.9％).The follow-up time was 0.23-5.40 years (medium:3.43 years),cumulatively 459675 person years,and 78 people were found to be HIV positive.The incidence rate of HIV infection was 0.170/1000 person years.The incidence rate was 0.037/1000 person years in age group 15-29 years,0.288/1000 person years in age group 30-44 years,0.210/1000 person years in age group 45-59 years,0.204/1000 person years in age ≥60 years;0.213/1 000 person years in males,0.130/1000 person years in females;0.248/1000 person years inHan ethnic group,0.149/1000 person years in Minorities;0.194/1000 in people with education level ≤junior middle school,0.046/1000 person years in people with education level ＞ junior middle school;0.070/1000 person years in the unmarried,0.194/1000 person years in the married and 0.425/1000person years in the divorced/widowed.Cox proportional hazards regression analysis showed that being male (HR=l.731),aged 30-44 years (HR=13.158),aged 45-59 years (HR=10.329),aged ≥60years (HR=8.291),unmarried (HR=3.162) and divorced/widowed (HR=2.689) were the risk factors for HIV infection,while the education level ＞ junior middle school (HR=0.132) was the protective factor for HIV infection.Conclusions By medium 3.43 years follow up,the cohort study showed that incidence rate HIV infection was 0.170/1000 person years in the community residents in Dali.Male,middle aged and old people,people with low education level,the unmarried and the divorced/widowed had relatively higher risk to be infected with HIV,Close attention should be paid to the prevention and control of AIDS in these populations.

Objective To understand the characteristics of newly detected HIV infection cases and related high risk behaviors in the areas with high HIIV infection prevalence in Yunnan province.Methods A questionnaire survey was conducted with census method during January to March 2016 among newly detected HIV infected persons in Dehong,Honghe,Lincang and Dali prefectures in Yunnan during 2012-2015.Results Among 451 HIV seropositive cases,the major transmission route of HIV was heterosexual contact,accounting for 92.5％ (417/451).The total awareness rate of AIDS related knowledge was 73.0％ (329/451).The rates of condom use at sex with regular sexual partners,occasional sexual partners,commercial sexual partners and men who have sex with men within 1 year before knowing their infection status were 48.7％ (167/343),4.2％ (7/165),9.9％ (15/151) and 0.0％ (0/3),respectively.The risk factors for using no condom at sex with regular sexual parmers included living at Dali,being farmer,unmarried,cohabitation,divorced and widowed,monthly income under 1 000 yuan (RMB),living in urban area before infection,knowing no AIDS related knowledge etc.The risk factors for using no condom at sex with occasional sexual partners included living in Dehong,Honghe and Lincang,aged ≤30 years and being farmer.The injecting drug users accounted for 8.2％ (37/450) and 75.5％ of these cases had received AIDS related intervention (340/450).Conclusion High prevalence of heterosexual transmission of HIV,poor AIDS related knowledge on awareness,high risk behavior and poor condom use and poor intervention service utilization were found among newly detected HIV infected persons in areas with high HIV infection prevalence in Yunnan.

Objectives:To investigate the proportion of MSM among males over 15 years old and analyze its related factors to provide a reference for estimation of MSM size.Methods:Using cross-sectional survey design, multi-stage sampling method, and street interception survey method, a survey was conducted on males over 15 years old in Kunming from October to December 2019, with an estimated sample size of 9 908.Results:Totally, 10 707 males were recruited from 30 sites in 5 counties, and 10 283 were effectively surveyed with a response rate of 96.0%. Respondents aged 16 to 40 accounted for 75.3% (7 748), senior high school or above 71.1% (7 312), and unmarried 49.8% (5 121). The proportion of homosexual behavior in the past half-year was 1.06% (95% CI: 0.86%-1.26%), and the age-adjusted rate was 0.97% (95% CI: 0.78%-1.16%). And multivariate logistic regression showed the associated factors for homosexual behavior as following: proportion of main urban area was 2.217 times (95% CI:1.004-4.895) that of the outer suburbs, registered residence outside Kunming was 0.421 times (95% CI:0.260-0.682) that of in Kunming, having been in Kunming ≤6 months was 2.282 times (95% CI:1.262-4.126) that of >6 months, senior middle school or above was 0.336 times (95% CI:0.228-0.495) that of junior middle school and below, and being married was 0.462 times (95% CI:0.303-0.705) that of unmarried. Conclusions:The proportion of over 15-year-old males who have recently practiced male-male behavior was close to 1.00% in Kunming. The relevant factors included survey areas with a permanent residency of Kumming, short-time residency, education level, and marital status. This study obtained the data and related factors, which provided a reference for estimating MSM size in Yunnan province.

Objective:To understand the willingness of pre-exposure prophylaxis (PrEP) use to prevent HIV infection and related factors in men who have sex with men (MSM) in Yunnan Province.Methods:Cross-sectional study method and snowball sampling method was used to carry out the survey in 14 cities (autonomous prefectures) in Yunnan from April to June 2021. According to national sentinel surveillance program, the sample size was 400 at national sentinel sites and 100 at provincial sentinel sites. The related factors of PrEP use willingness were analyzed by multiple logistic regressions with software SPSS 22.0.Results:A total of 2 450 questionnaires were completed, the rate of having heard of PrEP was 68.5% (1 677/2 449), the willingness rate of PrEP use was 56.7% (1 343/2 368), the willing rate of PrEP use at their own expense was 30.6% (724/2 368), and the willingness rate of free PrEP use was 56.2% (1 330/2 367). The of multivariate logistic analysis results showed that related factors of low willingness to use PrEP included aged 40-49 years and 50 years or above (a OR=2.49 and a OR=4.48), Han ethnic group (a OR=1.47), residence in other provinces (a OR=1.64), education level of senior high school (a OR=1.96) and college or above (a OR=3.49), sample source of bath house (a OR=3.53), online recruiting (a OR=2.53) and voluntary counseling and testing (a OR=1.42), local living time for 3-6 months and 7-12 months (a OR=0.18 and a OR=0.25) ,class 2 and 3 of survey areas (a OR=3.63 and a OR=1.71), having no anal sex with men in the past week (a OR=2.60), having no commercial homosexual behavior in the past six months (a OR=13.32) and self-perceived higer risk for HIV infection (a OR=0.50). Conclusions:There was more than half of MSM with willingness to use PrEP. The health education to promote PrEP use should be strengthen in MSM who had low willingness to use PrEP from underdeveloped areas, in Han ethnic group, with older age, from other provinces, with shorter local living time and self-perceived low risk for HIV infection.

OBJECTIVETo understand the prevalence of high risk behaviors and influencing factors among HIV infected persons aged ≥50 years.

METHODSFace to face questionnaire interview was conducted among the HIV infected persons selected in Jianshui, Gejiu and Mengzi counties in Yunnan province through random sampling in June 2015. The sample size was 450.

RESULTSAmong the HIV infected persons surveyed, 41.2% (122/296) had sexual behaviors with their spouses during past year, and the consistent condom use rate was 66.4% (81/122). Among the HIV infected males, 8.9% (28/313) had commercial sexual behaviors during past year, and the consistent condom use rate was 17.9% (5/28). Among the HIV infected females, 0.7% were still engaged in commercial sex service during past year. Among the 450 HIV infected persons, 32 (7.1%) reported having casual sex behaviors during past years, and the consistent condom use rate was 18.7% (6/32). The rate of commercial sexual behavior in urban residents (13.4%, 19/115) was higher than that in rural residents (4.5%, 9/198), the difference was statistically significant (χ(2)=11.715, P=0.001). The risk factors for commercial sex behaviors included lack of family and social support, aged 50-59 years, living in urban area, higher income and being male. The risk factors for using no condom included living in rural area, lower education level, lack of family and social support and higher income.

CONCLUSIONSRisk sex behaviors are still prevalent in HIV infected people aged >50 years, which exacerbated HIV transmission. Further efforts should be focused on the education about AIDS prevention and control and promoting protected sexual behaviors. Additional effort should be done to improve the family and social support for HIV infected people aged >50 years. Moreover, comprehensive intervention for low-paid female sex workers also needs to be strengthened.

China ; epidemiology ; Condoms ; utilization ; Female ; HIV Infections ; epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Risk-Taking ; Sex Work ; psychology ; statistics & numerical data ; Sexual Behavior ; psychology ; statistics & numerical data ; Surveys and Questionnaires