Objective:To understand the monkeypox knowledge awareness, risk perception and vaccination intention in men who have sex with men (MSM) in five cities in northeast China.Methods:A cross-sectional study was conducted by using electronic questionnaire in MSM selected by convenience sampling in five cities in northeast China (Shenyang, Panjin, Changchun, Harbin and Jiamusi) from June 28 to July 8, 2023 by local centers for disease control and prevention and MSM communities. The sample size was estimated to be 220. Information about their demographics, monkeypox-related knowledge awareness, perceived concern about epidemic risk perception, and monkeypox vaccination intention were collected. Logistic regression model was used to analyze related factors for MSM's monkeypox vaccination intention.Results:In 355 MSM, 63.9% (227/355) had monkeypox vaccination intentions, and 55.5% (197/355) had high awareness of monkeypox related knowledge with a mean knowledge awareness score of 3.7±1.5. MSM with education level of high-school and above (a OR=1.93, 95% CI:1.01-3.69), higher knowledge awareness score (a OR=1.19, 95% CI:1.02-1.40) and higher risk perception of monkeypox infection (a OR=1.82, 95% CI:1.15-2.88), were more willing to receive monkeypox vaccination. The main reasons for willingness to receive monkeypox vaccine were preventing monkeypox (86.3%, 196/227) and worrying about appearance being affected (62.1%, 141/227). The main reasons for unwillingness for the vaccination included concerns about vaccine safety (53.1%, 68/128), clinical progression of AIDS being affected (46.1%, 59/128) and efficacy of antiretroviral therapy being affected (44.5%, 57/128). Conclusions:The levels of knowledge awareness and vaccine intentions still need to be improved among MSM in five cities of northeast China. It is necessary to improve the awareness of monkeypox and intention of monkeypox vaccination, promote protected sex behavior and self-assessment of infection risk, reduce vaccine hesitancy and increase monkeypox vaccination intention in MSM in 5 cities in northeast China.

At present, the late diagnosis of HIV-infected patients is not optimistic, which has a significant impact on the efficacy, cost, and prognosis of HIV antiretroviral therapy and HIV transmission. Late diagnosis is an important indicator for evaluating HIV testing. This article reviews the influencing factors of late diagnosis of HIV-infected patients and provides a reference for formulating and improving HIV testing strategies and measures in China.

Objective:To understand the awareness rate of mpox knowledge and related factors among men who have sex with men (MSM) in China.Methods:The survey was conducted among men aged ≥18 years who had sex with men in the past year, using the convenience sampling method. The estimated sample size was 4 312. With the assistance of social organizations of MSM in 30 provinces in China, an online questionnaire survey was conducted using anonymous self-designed questionnaires powered by www.wjx.cn during 10-14 August 2023 to collect information on socio-demographic characteristics, awareness of mpox knowledge, travel history, and sexual behaviors of the respondents. The software SAS 9.4 was used for statistical analysis.Results:There were 7 725 respondents, and the age of the respondents was (31.6±9.0) years. The results revealed that the awareness rate of mpox knowledge was 50.1% (3 872/7 725). The main routes to acquire mpox knowledge were mainly new media, including WeChat, Weibo, TikTok, and Blued social software (88.4%,6 827/7 725), while official media report was the most trusted way to acquire related knowledge (79.3%,6 129/7 725). Multivariate logistic regression analysis revealed that the factors indicated a higher awareness rate of mpox knowledge, including living in the western region or the eastern region, people were over 26 years old in early adulthood and midlife, college-educated or with higher degrees, living in towns or urban periphery, being in homosexual or in bisexual relationships, 1-5 homosexual times/months in the past 3 months, knowing their HIV infection status, paying attention to mpox knowledge very often, occasionally or rarely, and convenient ways to acquire mpox knowledge from new media and social organizations.Conclusions:The awareness rate of mpox knowledge was low among MSM in China. Efforts should be made to improve the awareness rate of mpox knowledge among those who are young, less educated, or sexually active, with targeted health education via new media and social organizations.

Tracing the contacts exposed to high risk behaviors of HIV-infected patients can facilitate the diagnosis and discovery of HIV positive individuals for timely treatment and intervention to reduce secondary transmission, which is of great importance for the control of AIDS epidemic. With the development of HIV gene sequence detection and analysis technology, the application of HIV molecular transmission network in traditional contact tracing based on epidemiological investigation can contribute to the accurate reveal of HIV transmission mode, clarification of HIV transmission characteristics and identification of the population at high risk for HIV infection to provide evidence-based insights for the accurate prevention and control of AIDS. This paper summarized the progress in the research of tracing the contacts exposed to high risk behaviors of HIV-infected patients to provide reference for the AIDS prevention and control in the future.

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.

Objective:To understand the current status of monkeypox knowledge and related factors among men who have sex with men (MSM) in China.Methods:The survey was conducted in 30 provinces from September 5 to 10, 2022. With the assistance of social organizations of MSM, MSM respondents were recruited one-to-one by investigators through a convenient sampling method. Respondents log in to the questionnaire star to participate in the anonymous online survey. The sample size was estimated at 5 070 based on China's population infectious disease prevention literacy level of 25%. The self-administered online questionnaire collected information on sociodemographic, behavioral, HIV infection status, attention to monkeypox, and knowledge of monkeypox. The logistic regression model was used to analyze the factors associated with knowledge awareness of monkeypox.Results:Among 5 780 MSM subjects, the awareness rate of monkeypox knowledge was 31.8% (1 840/5 780). The results of multivariate logistic regression analysis showed that the related factors with higher awareness rate of monkeypox knowledge in MSM included the current address was in the eastern region ( OR=1.26, 95% CI: 1.01-1.56), college education level or above ( OR=1.50, 95% CI:1.14-1.97), the number of anal-sex partners in the last month was ≥3 ( OR=1.71, 95% CI: 1.28-2.28) or 2 ( OR=1.36, 95% CI:1.07-1.73), and there was no homosexual group sex in the last month ( OR=1.20, 95% CI:1.01-1.43), they had no heterosexual behavior ( OR=1.28, 95% CI:1.02-1.62), were HIV negative ( OR=1.85, 95% CI:1.44-2.36) or HIV positive ( OR=1.65, 95% CI:1.27-2.16), and paid frequent attention to monkeypox information ( OR=7.08, 95% CI: 5.28-9.48), occasional attention ( OR=4.52, 95% CI: 3.49-5.86) or minimal attention ( OR=2.55, 95% CI: 1.93-3.37). Conclusions:MSM has some attention and understanding of monkeypox in China, but the awareness rate of monkeypox knowledge is not high. It is necessary to strengthen the awareness of monkeypox knowledge among the MSM population with junior middle school education or below, who ignore the epidemic of monkeypox, have not been tested for HIV, and have had homosexual group sex or heterosexual sex to promote monkeypox prevention and self monitoring among MSM.

With the rapidly increase of HIV infections in the elderly in China, new challenges have emerged in HIV/AIDS prevention and control. Low awareness of HIV and common unprotected casual sex and commercial sex has made older people at higher risk for HIV infection. In addition, HIV-infected and higher risk elderly people have limited awareness of HIV-related knowledge and access to testing services due to low educational level and socioeconomic status. Furthermore, HIV-infected elderly people usually have elevated risk of death because of late detection and comorbidities of chronic diseases. More research should be made to further understand the behavioural characteristics and social, cultural and psychological determinants of the elderly, development and adoption of HIV prevention service strategy catering for the elderly's need, and strengthening whole-process comprehensive health management of elderly infected people.

Objective:To understand the epidemiological characteristics and changing trends of HIV-infected patients aged ≥60 years reported in recent years in China and provide reference for the development of HIV prevention and control strategies for the elderly.Methods:The data of newly reported HIV-infected patients aged ≥60 years between 2015 and 2022 were obtained from China Information System for Disease Control and Prevention. The differences in epidemiological characteristics of HIV infections among groups were compared by using t test and Kruskal-Wallis H nonparametric test in software SPSS 24.0. Software Joinpoint 4.9.0 was used to calculate annual percent change (APC) and trend analysis was conducted by using Joinpoint regression model. Software Excel 2019 was used for graph drawing. Results:The number of reported HIV-infected patients aged ≥60 years in China increased from 17 451 in 2015 to 27 004 in 2022, with newly diagnosed rate rising from 9.0/100 000 to 10.2/100 000. The newly diagnosed rate in men was higher than that in women. Trend analysis demonstrated that the newly diagnosed rate in both elderly men and women peaked in 2019 (APC for men=13.5%, P=0.003; APC for women=15.0%, P=0.002), and showed a downward trend after 2019 (APC for men=-12.4%, P=0.006; APC for women=-13.0%, P=0.007). Among the elderly infected men, those infected by heterosexual and homosexual transmission accounted for 93.5% (160 747/171 924) and 5.1% (8 781/171 924), respectively. Among the elderly infected women, those infected by heterosexual transmission accounted for 98.4% (48 899/49 697). The infected elder people diagnosed by medical institutions accounted for 71.5% (158 394/221 621), whose baseline CD4 +T lymphocytes level was lower than that in those diagnosed by other ways ( H=1 079.82, P<0.001). Conclusions:The poor risk awareness and high-risk sexual behavior made the elderly at higher risk for HIV infection. More efforts should be made to improve active surveillance, timely detection and origin-tracing for infected elderly for the accurate and effective prevention and control of HIV infection.

Objective:To analyze the basic characteristics and change trend of mortality in HIV-infected patients aged ≥60 years in China from 2013 to 2021.Methods:The data of HIV-infected patients aged ≥60 years at diagnosis were collected from China Information System for Disease Control and Prevention to calculate the mortality density. The trajectory model was fitted using the Proc traj process in software SAS 9.4 to explore trajectory of AIDS-related mortality density and non-AIDS-related mortality density under different combinations of region, gender and age.Results:Between 2013 and 2021, a total of 244 770 HIV-infected patients were reported with 40 079 AIDS-related deaths and 50 245 non-AIDS-related deaths. The AIDS-related mortality density was 6.32 per 100 person-years, and the non-AIDS-related mortality density was 7.92 per 100 person-years, both of which showed decreasing trends over the years, and the mortality density in men was higher than that in women. Two developmental trajectories could be categorized for different trends of AIDS-related mortality density: the lower mortality density group accounted for 80.95% and showed a slow decreasing trend; the higher mortality density group accounted for 19.05% and showed a three-curve developmental trend. There were three developmental trajectories of non-AIDS-related mortality density trends: the lower mortality density group accounted for 59.52% and the medium mortality density group accounted for 28.57%, with a flat overall trend in these two groups; the higher mortality density group accounted for 11.91% with a three-curve trend.Conclusions:The mortality in HIV-infected patients aged ≥60 years in China is still high. Further attention should be paid to the early detection, diagnosis and treatment of HIV infection to effectively reduce the density of AIDS-related deaths. At the same time, attention should be paid to non-AIDS-related deaths in the elderly, and comprehensive interventions should be taken. It is necessary to conduct targeted HIV/AIDS prevention and control based on actual situation in different areas and populations

Objective:To understand the epidemiological characteristics of HIV-infected farmers aged ≥60 years in China and provide evidence for the development of AIDS prevention and control policies for elderly farmers.Methods:Data of newly HIV-infected farmers aged ≥60 years reported between 2018 and 2022 were obtained from China Information System for Disease Control and Prevention. The differences in epidemiological characteristics of HIV infection between farmers and other populations were compared using χ2 test. Based on 6 representative indicators, 31 provinces were divided into three sub-epidemic areas of A, B, and C by using sample system clustering method in SPSS 24.0 software. Results:From 2018 to 2022, a total of 113 311 HIV infection cases in farmers aged ≥60 years were reported, accounting for 71.8% of the reported cases in this age group nationwide (113 311/157 792). In the 113 311 HIV infection cases, 86 517 (76.4%) were men, 80 176 (70.8%) were diagnosed by medical institutions, 80 667 (71.2%) were distributed in the western region and 92 191 (81.4%) had education level of primary school or below [higher than the proportion in other populations (49.8%, 22 165/44 481)]. In 113 311 HIV infection cases, 96.7%(109 562/113 311) were infected through heterosexual transmission, in whom 50.4% (55 184/109 562) had commercial heterosexual behavior, 9.1%(9 958/109 562) had fixed sexual partners, 40.5%(44 420/109 562) had other heterosexual behaviors. The clustering analysis indicated that in region A (Guangxi, Chongqing, Guizhou, Sichuan, Yunnan and Xinjiang), the proportions of people living with HIV (30.2/10 000), HIV-infected farmers aged ≥60 years in rural population (22.8/10 000), counties reported HIV-infected elderly farmers (93.4%), the population had HIV test (44.2%), were all higher than those in region B and C. Compared with region B and C, The net income of farmers (10 000 yuan) was lower in region A, and the proportion of commercial heterosexual behavior in male farmers in region A (41.0%) was slightly lower than that in region B (46.1%), but higher than that in region C (15.2%).Conclusions:HIV infections in farmers aged ≥60 years were mainly caused by heterosexual behaviors, such as commercial heterosexual sex, in China from 2018 to 2022. The low awareness of self-protection against AIDS and high-risk sexual behaviors are closely associated with HIV infection in elderly farmers. Attention should be paid to the behavior intervention and health education about AIDS prevention in elderly farmers and the prevention and intervention in rural female sex workers and HIV positive spouses should be strengthened.