Objective:To investigate syphilis infection and related factors among HIV-infected patients being followed up for more than one year in Zhejiang Province.Methods:Data were collected from the China Disease Control and Prevention Information System, and information such as demographic characteristics, viral load levels, and syphilis serologic test results was collected from HIV-infected persons who were diagnosed with HIV more than 1 year, aged ≥15 years with a current address in Zhejiang Province through December 31, 2022. The logistic regression model analyzed the prevalence of syphilis and the related factors. The SPSS 19.0 software was used for statistical analysis.Results:A total of 33 734 HIV-infected patients, with the prevalence of syphilis was 5.6% (1 879/33 734). Among the syphilis cases, the prevalence of syphilis was 6.4% (1 774/27 934) of males, 7.5% (640/8 543) of 25-34 years old age group, 7.6% (1 025/13 423) of unmarried, 8.3% (1 239/14 862) of homosexual transmission, 6.9% (214/3 080) with a non-local registered residence and 9.6% (602/6 267) with a history of STD before the HIV diagnosis. Multivariate Logistic regression analysis showed that participants who were male (a OR=2.19, 95% CI:1.77-2.72), 25-34 years old age group (a OR=1.80, 95% CI:1.47-2.20), homosexual transmission (a OR=1.67, 95% CI:1.49-1.88), with other provinces registered residence (a OR=1.26, 95% CI:1.09-1.47), and with a history of sexually transmitted disease (STD) before the HIV diagnosis (a OR=1.98, 95% CI:1.78-2.20) were associated with increased risk of syphilis. Being married (a OR=0.79, 95% CI:0.68-0.92) was associated with a decreased risk of syphilis. Conclusions:Syphilis infections were high in HIV-infected patients followed up more than one year in Zhejiang Province. It is recommended that syphilis surveillance and screening frequency should be strengthened among HIV-infected persons with characteristics such as male, homosexual transmission, and STD history.

Objective:To analyze the trends and related factors of HIV self-testing willingness in young students in Zhejiang Province, and provide evidence for the development of AIDS prevention and control measures in young students.Methods:From 2017 to 2021, HIV/AIDS sentinel surveillance was carried out in students of colleges and universities in all 11 cities of Zhejiang Province. One university or vocational and technical college in each city was selected as a sentinel school. An anonymous questionnaire survey was conducted among 800 students aged ≥16 years and selected by phased cluster sampling in each university or college from April to June in each year to collect information about their social demographic characteristics, sexual behavior, HIV prevention and test services acceptance. The HIV self-testing willingness and the influencing factors were analyzed.Results:A total of 45 483 students were surveyed from 2017 to 2021, and the proportions of those with willingness of HIV self-testing were 0.4% (35/9 107), 3.7% (334/9 150), 5.2% (475/9 203), 6.3% (563/8 962)and 7.4% (674/9 061) respectively (trend χ2=582.74, P< 0.001). Among young students who had sexual contact history, the multivariate logistic regression analysis showed that factors related with higher willingness of HIV self-testing included those majoring in medicine ( OR=1.57, 95% CI:1.06-2.33), seeking sexual partners through internet or social-dating application ( OR=1.96, 95% CI:1.33-2.89), receiving HIV prevention services in the last year ( OR=1.33, 95% CI:1.02-1.74), and being heard of vending machines selling HIV test kits ( OR=1.80, 95% CI:1.34-2.41). The factors related with lower willingness of HIV self-testing inclued those who had multiple heterosexual partners ( OR=0.57, 95% CI: 0.36-0.89). Conclusions:The willingness of HIV self-testing in young students increased in Zhejiang during 2017-2021, the young students who had sex were more willing to self-test among them but the level was still low. It is necessary to further strengthen the health education of HIV/AIDS prevention and control and provide better testing services to promote HIV self-testing.

Objective:To investigate the prevalence of syphilis in HIV-infected patients with transmission risk and influencing factors in Zhejiang Province.Method:The information about the HIV-infected patients, who were alive, had been diagnosed with HIV for >1 year, had received no antiviral treatment or had HIV viral load ≥50 copies/ml, and were aged ≥15 years, reported in Zhejiang as of December 31, 2018 were collected from China Information System for Disease Control and Prevention. The information included general demographic characteristics, sexual behavior characteristics and antiretroviral therapy and syphilis serological test results. The prevalence of syphilis and the influencing factors were analyzed by logistic regression model. The SPSS 19.0 software was used for statistical analysis.Results:A total of 2 275 HIV-infected patients were at risk of HIV transmission, and 75.5% (1 717/2 275) of them were tested for syphilis, the prevalence rate of syphilis was 8.7% (150/1 717). Among the HIV-infected patients with syphilis, 11.3% (17/150) received no antiviral treatment, 38.7% (58/150) had viral load of 50-999 copies/ml and 50.0% (75/150) had ≥1 000 copies/ml. Multivariate logistic regression analysis showed that being men (a OR=2.04, 95% CI:1.06-3.96), homosexual transmission (a OR=1.53, 95% CI:1.04-2.27), history of sexually transmitted diseases (STDs) before HIV diagnosis (a OR=1.98, 95% CI:1.35-2.92) and HIV viral load ≥1 000 copies/ml (a OR=1.90, 95% CI:1.09-3.30) were the risk factors for syphilis. Marriage (a OR=0.47, 95% CI: 0.29-0.76) was a protective factor for syphilis. Conclusions:The prevalence of syphilis was high in HIV-infected patients with transmission risk in Zhejiang. It is urgent to carry out classified management and targeted intervention in HIV-infected patients, explore multi-disease prevention and treatment mechanism, strengthen syphilis screening and treatment in HIV-infected patients to reduce the transmission of HIV and syphilis.

Objective:To understand the epidemiological characteristics and transmission routes of newly reported HIV/AIDS cases with non-martial and non-commercial (NMNC) heterosexual behaviors in Zhejiang province.Methods:A retrospective survey was conducted among HIV/AIDS cases that had NMNC heterosexual behavior history and diagnosed with HIV infection in Zhejiang between January 1 st, 2017 and September 30 th, 2019. The multiple correspondence analysis (MCA) was used to explore the association of social demographic characteristics with NMNC heterosexual partner types in the cases. Results:A total of 406 participants with NMNC heterosexual behaviors before HIV diagnoses were recruited in this study. Most of them were males (67.2%, 273/406), aged 25-49 years at HIV diagnoses (59.1%, 240/406). Prior to HIV infection confirmation, 36.0% (146/406) participants only had casual sexual partners, 52.0% (211/406) only had regular sexual partners, and 12.0% (49/406) had both. Statistical differences in marital status, occupation and income level were found among participants with different types of NMNC heterosexual partners (all P<0.05). Result of MCA indicted that monthly income ≤3 000 yuan RMB, self-employed, being married were only associated with casual NMNC heterosexual partner; working in service industry, education level of junior high school were only associated with regular heterosexual partner; working in enterprise, high school education level or above, monthly income ≥5 000 yuan RMB were associated with both casual and regular sexual partner. Conclusion:The HIV/AIDS cases with NMNC heterosexual behaviors before HIV diagnoses accounted for a large proportion in Zhejiang province during 2017-2019. Active intervention efforts should be made to improve the health awareness of the public to reduce the risk behaviors for HIV transmission.

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.

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.

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.

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