title: Increasing HIV and decreasing syphilis prevalence in a context of persistently high unprotected anal intercourse, six consecutive annual surveys among men who have sex with men in Guangzhou, China, 2008 to 2013.
abstract: BACKGROUND
  Previous studies have reported a possibly increasing HIV prevalence among men who have sex with men (MSM) in China. However there have been limited systematic analyses of existing surveillance data to learn the trend of HIV prevalence and factors driving the trend. The aims of this study were to examine the trend of HIV prevalence among MSM in Guangzhou and to explore the role of unprotected anal intercourse (UAI) in the trend.
  
  
  METHODS
  Snow-ball sampling was applied in the subject recruitment for the annual serological and behavioral surveys among MSM from 2008 to 2013. Data collected in the behavioral survey include demographic information, HIV related sexual behavior with men and women, access to HIV prevention services, and symptoms of sexually transmitted infections. Chi-square test was used to analyze the trend of HIV prevalence. Multivariate logistic regression was conducted to test the factors associated with HIV infection.
  
  
  RESULTS
  HIV prevalence increased significantly from 5.0% in 2008 to 11.4% in 2013 while syphilis prevalence decreased from 17.4% to 3.3% in the same period. UAI rates were high and stable in every single year, ranging from 54.5% to 62.0%. Those who were having UAI (OR = 1.80, 95% confidence interval (CI): 1.26-2.58), being migrants, having more than 10 partners, and infected with syphilis had higher risk for HIV infection.
  
  
  CONCLUSIONS
  HIV epidemic is expanding in Guangzhou. The persistently high UAI may have played a major role in the increasing trend of HIV prevalence. Targeted prevention program should be conducted among MSM who are migrants, low educational level, syphilis infected, or having multiple partners to encourage HIV test and change UAI behavior. The general high UAI calls for tailored intervention program to promote healthy culture and form a safe sex social norm in the MSM community.
authors: School of Public Health, Sun Yat-sen University, Guangzhou, China; Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China; Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
authors: Fei
authors: F
authors: Zhong
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Boheng
authors: B
authors: Liang
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Huifang
authors: H
authors: Xu
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Weibin
authors: W
authors: Cheng
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Lirui
authors: L
authors: Fan
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Zhigang
authors: Z
authors: Han
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Caiyun
authors: C
authors: Liang
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Kai
authors: K
authors: Gao
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Huixia
authors: H
authors: Mai
authors: Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
authors: Faju
authors: F
authors: Qin
authors: The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors: Jinkou
authors: J
authors: Zhao
authors: School of Public Health, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
authors: Li
authors: L
authors: Ling
mesh_terms: D000328:Adult; D002681:China; D003075:Coitus; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D006679:HIV Seropositivity; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012725:Sexual Behavior; D013587:Syphilis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D047568:Unsafe Sex