| BackgroundHeterosexual transmission route is the predominant mode of human immune-deficiency virus transmission worldwide, including China. Heterosexual transmission accounted for 44.9% of all reported cases in China in 2009.But sentinel surveillance system in China did not capture high HIV antibody positive rate among female sex workers and antenatal clinic attendees. What is the cause of it? And what is the main composing of heterosexual transmission? Sex with committed partner, commercial partner, or non-commercial casual partner? At the same time, high HIV prevalence was already observed among MSM in China, the rate of HIV infection among MSM increased year after year. Sentinel surveillance data in 2009 showed that one third of the MSM self-reported to have heterosexual partners in behavior surveillance system. Then what is the proportion of HIV transmission caused by bisexual heterosexual of MSM in China?ObjectivesTo find out the main pathway and characters of heterosexual transmission of HIV in several provinces in China, to study the characters of different patterns of HIV heterosexual transmission.MethodFrom June to August,2010, a cross-sectional study was performed to interview the socio-demographic characteristics, heterosexual transmission patterns among reported heterosexual transmission HIV positive adults in 2009 in several provinces in China. Considered the epidemiology characters and geographical distribution of HIV/AIDS in China, we chose four provinces, including Guangxi, Sichuan, Chongqing and Heilongjiang province, which range from low HIV prevalence locations to high HIV prevalence locations. Face to face interview to HIV positives was used for quantitative investigation by training health workers in local CDC. Group discussion and deep interview were conducted by personnel from China CDC. Before investigation, vocal consent of participants was finished. No blood or other specimens were collected for the study. Quantitative questionnaires including:socio-demographic information of the participants, high-risk behavior exposure information, heterosexual activities and characters of sexual behaviors. Group discussion and deep interviewing including:group discussion for health workers:working and training experiences, work pressure, the barriers, main ways, difficulties and recommendations of HIV case interviewing, etc. Deep interviewing to HIV positive adults including:characters of sex behaviors, discrimination and stigma experiences, social pressure, risk behavior, etc.ResultsA total of 676 HIV positive adults were recruited with informed consent for study, of these 394 are male,282 are female.47.6%(322/676) of them reported that they were infected by commercial sexual partner,28.1%(190/676) were infected by committed/fixed sexual partners, and 24.3%(164/676) were infected by non-commercial casual sexual partners.Among HIV positive adults who were self-reported to be infected by commercial sexual partners,73.9% of them are male. HIV positive adults elder than 50 years old accounted for 35.1% of all, who had more commercial sexual partners than people in other age groups, and the rate of condom use are lower than people in other age groups. Most of male HIV positive adults had commercial sexual intercourses in low graded sex venues, which accounted for 65.4%of all. The rate of condom use in low graded sex venues was lower than that in high.Among HIV positive adults who were infected by casual sexual partners,54.9% of them are below 30 years old,54.3% of them are female.58.5%of them had other casual sexual partners, 10.4% of them were drug users,6.7% of them were commercial sexual workers.Most of HIV positive adults who were infected by committed/fixed sexual partners are female, accounting for 85.3% of all.6 of them were infected by bisexual men, accounting for 3.7% of female HIV positive adults who were infected by committed/fixed sexual partners, accounting for 2.1% of female HIV positive adults.ConclusionsThe main pathway of HIV heterosexual transmission in several provinces is commercial sexual transmission. Most of HIV positives had commercial sexual intercourses in low graded sex venues, the rate of condom use in low graded sex venues was lower than that in high.HIV positive adults elder than 50 years old should not be neglected. Most reasons of not using condom in commercial behaviors are "Don't like them", "Didn't think of it", "Not available", it shows that in commercial sex behaviors clients play an important role for whether to use condoms. While interventions to sex workers are carried out, the interventions to clients should be taken into account at the same time.HIV positive adults elder than 50 years old accounted for 35.1% of HIV positives infected by commercial sexual partners, who had more commercial sexual partners than people in other age groups, and the rate of condom use are lower than people in other age groups, a further research to elder men should be performed.Most of HIV positive adults who were infected by committed/fixed sexual partners are female, this might be related to biological susceptibility and the dominant position of men in family, health education and intervention related to AIDS for women, antiretroviral therapy, voluntary counseling & testing are important for the prevention of HIV through committed sexual partners.In the survey, HIV positive adults infected by bisexual men accounted for a low proportion. But given the social discrimination and the secret of bisexual men, the results may not fully reflect the heterosexual transmission of bisexual men.In the survey, some reported pathway of HIV positive adults were wrong, perhaps it was because that some HIV positives did not want to reveal their HIV high-risk behaviors, especially homosexual behaviors, to improve the quality and validity of report system of HIV, participation of non-governmental organizations should be considered in the first epidemiological survey. |
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