Sexual Networks And HIV/AIDS Epidemiology Among HIV-discordant Couples And Rural Community Residents In Dehong Prefecture, Yunnan Province

ObjectivesThe study was conducted in Dehong prefecture, Yunnan province with specific aims (1) to evaluate the risk behavior of HIV transmission within HIV-serodiscordant heterosexual couples (hereafter referred to as "DC couple") and examine the correlates of the risk behavior, and describe the HIV related risky networks of these couples, (2) to investigate the sero-prevalence and correlates of STI among DC couples, and (3) to examine the sero-prevalence and correlates of HIV/STI among general rural populations and to profile their sexual networks.Methods(1) The study of DC couples was conducted in Dehong prefectures, and DC couples were enrolled from 34 townships clustered with 20 or more HIV infected individuals. All the couples participatd in the study were interviewed to collect demography and behavior information, HIV infected subjects were tested for HIV viral load, CD4 count, HSV-2 and syphilis, and HIV negative parters were tested for HSV-2 and syphilis.(2) The study among general rural populatioins was conducted in a rural community cluster with 10 villages geographically continued. All permanent residents aged 16 to 55 who were able to provide informed consent were recruited for the study. All subjects were interviewed and tested for HIV, syphilis and HSV-2.Results(1) Of the 984 DC couples enrolled,77.4% of the HIV-1 infected partners were male and 22.6% were female. Of the DC couples,21.0% had sex but inconsistently used condoms within three months; needle sharing was not observed within these couples. The couples' average age was correlated with inconsistent condom use, those aged less than 26 (OR=2.27, 95%CI:1.08-4.74) and aged 26-35 (OR=2.15,95%CI:1.17-3.96) were more likely to involve inconsistentt condom use than those aged above 46 years old. Jingpo couples were 2.29 fold more likey to inconsistently use condoms than Han couples were (OR=2.29,95%CI: 1.40-3.75). The couples without offspring had a higher proportion of inconsistent condom use than those with offspring (OR=3.64,95%CI:2.30-5.76). Inconsistent condom use were more common among couples who were not followed by medical staff regularly (OR=1.45, 95%CI:1.04-2.04) and who were not provided free condoms (OR=2.35,95%CI:1.51-3.65). A few HIV-infected subjects shared needles and a percent of 5.2 had multiple sexual partners within 12 months.(2) Of 976 couples enrolled and tested,47.5% were infected with either HSV-2 or syphilis. Of the HIV-infected subjects,3.1% were tested syphilis positive, and 39.0% were tested HSV-2 positive and the correlates of HSV-2 infection were gender, age, ethnic and HIV transmission route. Females subjects were 2.80-fold more likely to have HSV-2 than males (OR=2.80,95% CI:1.92-4.10), HSV-2 were less common among those aged 36-45 years old than those over 46 years old (OR=0.59; 95% CI:0.38-0.91), and were less common among Jingpos (OR=0.63,95% CI:0.42-0.94) than Hans, those acquired HIV through heterosexual behavior had a higher prevalence than those infected through injection drug use (OR=2.28, 95% CI:1.62-3.22), and those reporting any commercial sex had 1.67 fold more likely to have HSV-2 than those without commercial sex. Among HIV negative partners, the prevalence of syphilis was 1.4% and HSV-2 was 30.8%. The correlates of HSV-2 among them were gender, education, and their partner's HSV infection status. Females were more likely to be infected with HSV-2 (OR=4.53,95% CI:2.91-7.04), HSV-2 were more common among those with primary school level (OR=1.68,95% CI:1.06-2.68) and junior high school or above (OR=1.76,95% CI:1.04-2.96) than the illiterates, subjects with an HSV-2 positive partner had a 17.35 (OR=17.35,95% CI:11.97-25.16) fold more likely to had HSV-2.(3) The overall HIV prevalence among rural general population was 5.5%; the Jingpo minority had the highest prevalence (7.6%). Most participants were sexually experienced and 32.5% had had multiple sex partners. About 18.8% had used drugs, with the highest proportion among the Jingpo minority. HIV infection was independently correlated with drug use among males and with multiple sex partners among females. A total of 336 independent sexual network components (mostly small, linear, and acyclic) were constructed. Eighty-percent were dyads involving two members and 20% involved 3 to 71 members. Several HIV-infected participants presented relatively complex sexual networks.ConclusionsThere was potential risk of HIV transmission among DC couples and those youger, Jingpo and those without offspring were at higher risk of transmission. A few HIV infected partners from DC couples engaged in risky behavior such as sharing needles and multiple seuxla partners, and had potential risk of HIV spread. STI were common among DC couples. Awareness of STI correlates and treatment of both partners may reduce HIV-1 transmission. Coupled with the promotion of condom use, gender-specific efforts are needed for HIV prevention targeting ethnic minorities in Yunnan Province:to prevent drug use among males and to decrease having concurrent multiple sex partners (including those who use drugs) among females.