OBJECTIVETo explore and analyze the feasibility of Community Health Service Center(CHSC)-based HIV prevention and intervention in China.

METHODSData on case finding and case management indexes were collected from 42 CHSCs in 8 cities from November, 2011 to December, 2012, and complemented by questionnaires to investigate the willingness to accept community-based HIV services among health care providers and the service targets.

RESULTSDuring November, 2011 and December, 2012, 6 729 person-times HIV tests were carried out among MSM in the cooperation between CHSCs and CBOs, and 235 HIV positives were found. A total of 40 CHSCs among 42 have conducted HIV rapid tests. The sample sources were broad and the HIV screening positive detection rate from high-risk populations in key divisions of CHSCs 0.66% (38/5 769) was higher than that in outreach high-risk populations 0.41% (15/3 623) and people receiving physical check 0.31% (20/6 532). HIV positive detection rate in CHSCs was higher 0.4% (96/23 609) than that in conventional medical institutions 0.1% (11 870/9 644 944) and newly found positives among the confirmed positives was a little lower 73.7% (56/76) than conventional programs 80.1% (8 038/10 039). The case follow-up and CD4(+) T cell testing rates in CHSCs were 100.0% (1 046/1 046) and 99.1% (1 037/1 046), respectively. The testing cost was 6.1 RMB per person on average, and the cost of 1 case found positive was 2 727.3 RMB on average. Among 361 service providers, 68.1% (246)and 91.4% (330) service providers were willing to be involved in AIDS response and support HIV service in local CHSCs. Among 755 service targets including people who seek health care in key divisions of CHSCs, MSM, and high-risk populations in local communities, 77.3% (348), 73.9% (173) and 78.1% (57) were willing to accept free HIV tests in local CHSCs.

CONCLUSIONThe effect of case finding and case management in CHSCs was good and the cost of conducting HIV tests and finding new cases were relatively low, meanwhile, most of the service provides in CHSCs and service targets support HIV service in local CHSCs. The future CHSC-based HIV prevention and intervention was feasible.

China ; Community Health Centers ; Community Health Services ; HIV Infections ; prevention & control ; HIV Seropositivity ; Health Care Costs ; Humans ; Mass Screening ; Surveys and Questionnaires

OBJECTIVETo understand the syphilis infection and its high risk factors among men who have sex with men (MSM) recruited from different channels.

METHODSSupported by the China-Gates Foundation HIV program from July to December 2011, we cooperated with community based organizations to conduct syphilis testing intervention among MSM from 14 cities (Beijing, Shanghai, Tianjin, Chongqing, Harbin, Shenyang, Qingdao, Xi'an, Nanjing, Wuhan, Hangzhou, Changsha, Kunming, and Guangzhou) and one province (Hainan province). Participants were recruited from different channels by the staff of local CBOs, Demographic (e.g. age, marital status, and education) and behavioral (e.g. condom use and sexual partners) data were collected using anonymous questionnaires. Blood samples were also collected to test for syphilis. A total of 34 100 MSM participated in the survey. Participants were excluded from data analysis (1 399, 4.1%) if they did not receive syphilis tests or they completed less than 80.00% of the key questions in the survey. Chi-square tests were used to understand the socio-demographic and behavioral differences between each group. Results of syphilis tests were also compared. Logistic regression models were used to test the statistical significance of these differences.

RESULTSA total of 32 701 MSM were enrolled and received syphilis testing. The average age of participates was 30.96 ± 9.57. And among them, 2 284 cases (7.0%) were recruited from gay bathhouses, 4 774 (14.6%) from gay bars, 6 266 (19.2%) from the internet, 1 997 (6.1%) from the parks/toilets and 17 380 (53.1%) from other channels. MSM recruited from the bathhouses had the highest syphilis infection rate than other 4 groups: gaybars (4.5%, 216/4 774), internet (6.7%, 422/6 266), parks/toilets (8.3%, 166/1 997), other channels (6.4%, 1 103/17 380) (χ² = 164.58, P < 0.001). The multivariate logistic regression analysis showed that being > 20 years of age (P < 0.001), having more than 2 homosexual partners in recent 3 months (8.0% (1 408/17 714), OR (95% CI) = 1.44 (1.04-1.98)), having no sex with females in past 3 months (6.8% (1 446/21 276), OR (95% CI) = 1.25 (1.07-1.46)), and not using condom at last anal sex (8.0% (769/9 668), OR (95% CI) = 1.13 (1.03-1.25)) were associated with a higher probability of being infected with syphilis. Whereas MSM married (7.2% (456/6 305), OR (95% CI) = 0.84 (0.73-0.98)), having a college or a higher education (5.3% (829/15 684), OR (95% CI) = 0.60 (0.53-0.67)), being local residents (6.5% (1 843/28 185), OR (95% CI) = 0.73 (0.61-0.87)) and living in the local province of project cities (6.6% (170/2 593), OR (95% CI) = 0.67 (0.53-0.85)) were protective factors.

CONCLUSIONMSM who were recruited from gay bathhouses have a higher rate of syphilis infection than those in channels relatively. They are older, with low education levels and high-risk sexual behaviors. Tailored interventions are required in the future, especially for MSM from gay bathhouses.

Adult ; China ; Condoms ; Demography ; Homosexuality, Male ; Humans ; Logistic Models ; Male ; Risk Factors ; Safe Sex ; Sexual Behavior ; Sexual Partners ; Surveys and Questionnaires ; Syphilis ; Universities