Urgent action needed on HIV in Heilongjiang

by Michael Woodhead

A HIV epidemic in Heilongjiang has shown explosive growth since 2009 and homosexual contact has become the dominant route of HIV transmission, research shows.

Dr Shao Bin and co-researchers at the Public Health College of Harbin Medical University says action is urgently needed to curb the HIV outbreak in the northeast.

Analysing data from the provincial surveillance system for HIV infections, they found there had been 3062 HIV-infections in the area up to 2012, with 426 deaths. Since 2007, homosexual transmission has increased and become the dominant route of HIV transmission, accounting for 58% of cases during 2009–2010, and 69% during 2011–2012.

Gay men with HIV infections tended to be younger (21–30), unmarried, urban residents and have college or higher education.

“The current existing prevention strategy is not enough to prevent new infections. … Urgent intervention is needed to recognize and target this population, ,” the researchers said

Full study: Journal of Infection

Journal watch China

China has 1.5 million people disabled in road traffic accidents, or one in a thousand, according to a survey conducted by physicians published in the Journal of Public Health.

The high levels of air pollution recently seen in Chinese cities such as Beijing will increase deaths from strokes, according to research at Fudan University, Shanghai. Published in the journal Stroke, a study  carried out in eight Chinese cities found that for every 10 μg/m3 increase in  outdoor air pollution (particulate matter <10 μm in aerodynamic diameter, sulfur dioxide, and nitrogen dioxide) there is a 1.5% increase of stroke mortality.

Anaemia in pregnancy is causing mental retardation in Chinese children, according to a study from western China. The two year follow-up of 850 children born to women who took part in a trial of prenatal folic acid and iron supplementation in western rural China found that children whose mothers had iron deficiency anaemia in the third trimester showed a significantly lower mental development index at 12, 18, and 24 months of age. However, prenatal supplementation with sufficient iron protects child development even when the woman’s anaemia is not fully reversed, the study published in Pediatrics shows.

Sexually transmitted infections are common in prostitutes, a study of more than 3000 sex workers in eight Chinese cities has found. According to the findings published in the journal BMC Public Health, the overall prevalence rates of HIV, syphilis, gonnorheoa and chlamydia were 0.26%, 6.5%, 5.9% and 17%, respectively.

Toxic fungi are present in drinking water supplies in in Xiamen, a study  has shown. Analysis of water samples from four parts of the city found that the mycotoxigenic fungi Fusarium sp., Exophiala sp., and Phialophora sp were present in "with high frequency" in samples. " Some detected strains may directly cause human health problems," say the researchers from Xiamen University.

China medical news in brief

Headache and migraine a problem for one in ten Chinese children

A study of 4812 children and adolescents in Shanghai, China has found that 10% experienced a headache in the past three months. Of those who had headache, 45% were classified as having migraine. with the highest rates of migraine found at ages 14 years and 15 years. Tension-type headache accounted for 29% of headaches, while  cluster and other headache were responsible for 6.2% and 20%, respectively.
Source: Clinical Journal of Neuroscience 

Zhejiang prostitutes have high HPV rates and cervical cancer risk

Two out of three sex workers are infected with high risk subtypes of HPV putting them at increased risk of cervical cancer, a Zhejiang study has found.
Cervical samples from almost 300 female sex workers  in Huzhou, Zhejiang, showed that the prevalence of HPV was 67%, compared to 19% in the general population. Among the different types of HPV found,  HPV-16 (29%) was the most prevalent, followed by HPV-58 (24%) and HPV-52 (21%), and these were significantly associated with abnormal cervical cytology. The rate of cervical abnormalities was also higher among female sex workers (21%) than among the general population (5%). Researchers from the Huzhou Central Hospital conclude that female sex workers in the city have a greater probability of being infected with high-risk HPV, and novel vaccines against HPV-58 and HPV-52 should be developed. Using condoms could reduce the risk of infection.
Source: International Journal of Gynecology & Obstetrics 

Jiangsu simplifies medical insurance claims

Medical insurance claims can now be settled on the spot for outpatients in  Jiangsu. Outpatients from 13 cities including Changzhou, Nantong, and Wuxi can immediately settle their medical insurance if they go to see a doctor with their medical insurance cards, according to Jiangsu provincial Human Resources and Social Security Bureau.
Source: Jiangsu China.


Gay men in Yunnan have high HIV risk

More intensive HIV and STD screening and prevention campaigns are needed for gay men in Yunnan, say researchers who found a high incidence of new infections. In an 18 month study of 378 seronegative gay men in Yunnan they found that 11 became infected with HIV and 15 were infected with syphilis. Subgroups at high risk included students, retirees and minority ethnic groups, say the researchers from the No.1 Hospital of China Medical University, Nanjing.
Source: BMC Infectious Diseases.

Journal watch - clinical news

Waste water from Beijing hospitals is replete with anti-psychotics, antidepressants and sedatives.  
Source: Chemosphere.

Many Chinese people with depression have chronic back pain or neck pain.
Source: Psychiatric Research

Concern about drug resistant malaria from Plasmodium vivax in Central China.
Source: Korean Journal of Parasitology.

Almost 60% of prostitutes on China-Vietnam border have herpes, 5% have HIV.
Source: Biomedical and Environmental Sciences

Backyard duck breeders in Beijing at risk of avian flu.
Source: PLOS One.

In Shenzhen, rent boys have safer sex and lower HIV rates

Among gay men, those who sold sex had higher rates of condom use and lower rates of HIV

 by Michael Woodhead
Gay men who sell sex to to other men have higher rates of consistent condom use and lower rates of HIV,  researchers in Shenzhenhave found.
They say HIV transmission among men who have sex with men  has become an increasing concern in China. Money boys are a subgroup of gay men who sell sex to men. Direct comparison of HIV prevalence and related risk factors between "money boys" and non-commercial men who have sex with men has rarely been done.
Therefore, researchers studied HIV rates in 850 "money boys"  and 801 "non-commercial" gay men  in Shenzhen They found that the prevalence of HIV was 4.5% in "money boys" and 7% in  other gay men. Although "money boys" tended to have more male partners than  gay men, they were more likely to report a consistent condom use in male anal intercourse, especially in commercial sex. Noncommercial  gay men were more likely to visit parks and saunas instead of bars, massage centres, recreational centres, and home-based venues.
Syphilis infection and type of 'pick up' venue were associated with HIV infection in both "money boys" and  gay men. Being from a hometown with a high HIV prevalence was a risk factor for HIV infection in "Money boys", and early sexual debut was a risk factor in non-commercial gay men.
The researchers conclude that "money boys" differ from  gay men in the rate of HIV infection and some sexual characteristics and behaviours. Different safe sex and HIV-prevention promotion interventions specifically targeting the two subgroups may be necessary, they say.
Source: Sexually Transmitted Diseases

Sex imbalance gives Chinese men the blues

The skewed sex ratios in China contribute to depression, especially in unmarried men

by Michael Woodhead
The highly unbalanced sex ratios in parts of China are contributing to depression and suicidal tendencies in men, and women, but especially unmarried men, new research shows.
Dr Zhou Xudong and colleagues at the School of Public Health, Zhejiang University, Hangzhou, looked at depression rates in  7435 men and women aged 19–40 in Zhejiang, Yunnan and Guizhou. Depression was measured using the Chinese version of the Beck Depression Inventory (BDI).
They found depression in 17.6% of men and 17% of women, and suicidal thoughts and wishes in 18% and 20% of women respectively. The main factors associated with depression and suicidal thinking in men were high local sex ratio, rural residence, low education and poor economic status. Very high local sex ratio was the strongest independent determinant of depression in men.
The researchers conclude that "proactive measures need to be taken to identify and treat vulnerable individuals."
Read more: Journal of Affective Disorders

Clinical news in brief ....

Chinese herbalists at high risk of bladder cancer

Practitioners of traditional Chinese medicine who handle the toxic herb fangchi are at high risk of bladder cancers, a study has shown. Fangchi contains aristolochic acid which is known to cause urothelial carcinoma. Fangchi is commonly used in the Chinese herbal medicine industry and a study of 6,564 Chinese herbalists found that processing, selling or dispensing herbs containing fangchi significantly increased their risk of urothelial carcinoma  by more than a factor of two.
"Exposure to the Chinese herbal drug fangchi increases the risk of urothelial carcinoma in herbalists. Appropriate medical monitoring is warranted for workers who have similar exposure," say researchers.
Read more: Journal of Urology

Bone loss factors in Chinese postmenopausal women

With advancing age, lean mass begins to decrease in women aged over 65 years, but fat mass levels show no significant difference between the age groups. Both fat mass and lean mass positively correlate with bone mineral density decreasing rates. Fat mass is the most significant determinant of bone loss at the lumbar spine, whereas lean mass is the most significant determinant of bone loss at the femoral neck and total hip.
Read more: Endocrine Journal

50% of rural women have reproductive tract infections

A study of 1500 women aged 30 to 59 years old in Shanxi Province found that 54% had reproductive tract infections such as cervicitis, trichomonas vaginitis, and bacterial
vaginitis. The study also showed that 14% had suspicious benign breast disease , 1.4% had cervical precancerous lesions and 0.2% had suspicious breast cancers. All the women expressed interesting taking part in a low cost program of combined screening for  cervical cancer, breast cancer and
reproductive tract infections (RTIs).
Read more: Asia Pacific Journal of Cancer Prevention


Mercury causes birth defects in Chinese infants

High levels of mercury found in some pregnant Chinese women increase their risk of having a baby with neural tube defects, a study from has shown. Researchers from the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University found that the risk of neural tube defects was up to 18 times higher for babies who had in utero exposure to higher levels of mercury.
Read more: Reproductive Toxicology

The sexual behaviour of Chinese students - cause for concern?

About 13% of students have sex before marriage - but few talk about contraception

by Michael Woodhead

In China, sexual health and behaviors of young people have become a growing public concern but few studies have been conducted to investigate the prevalence and psychosocial correlates of the phenomenon. A self-reported questionnaire survey on youth sexual behaviors was conducted among 1,500 university students in 2011 at Hefei, a middle-size city in eastern China.
About 13% of students reported having pre-marital heterosexual intercourse (15% of male versus 9% of females).  About 11%  of students had oral sex (10.5% of males versus 11.2% females); 2.7%  of students reported same-sex activities (3.4% of males versus 1.7% females); Almost half  the students reported masturbation (70% of males versus 11% of females);  In addition, 57%  of Chinese students viewed pornography (86% of males versus 16% females). 
In terms of sexual communication about sexual knowledge acquisition, 14% talked to their parents about sex (11% of males versus 18% of females); about 7% of students reported having conversation with parents on contraception. About forcing sexual behavior, 2.7% (4% of males versus 0.9% of females) reported forcing their sexual partners to have sex, while 2.4% of males and 1.2% of females) reported being forced to have sex. 
Gender was a significant predictor of sexual behaviors in university students: males reported more sexual behaviors including sexual fantasy, heterosexual intercourse, masturbation, viewing pornography and talking about sex with friends.  For males, having romantic relationships, past sex education experiences, low educational aspirations, time spent on the Internet, and urban background were significantly associated with more sexual behaviors. For female students, having romantic relationships and urban native settings predicted sexual behaviors.
The authors of the report conclue: "Sexual behavior among University students in China is not uncommon, although there are limited ways for students to acquire sex-related knowledge: male students showed significantly more sexual behaviors than female students."
Since having romantic relationships and more time spent online were important predictors of sexual behaviors among university students they suggest that to guide healthy sexual behaviors in young people, "comprehensive sex education programs that provide necessary sexual health knowledge about safe sex should be developed and implemented in universities in China, particularly for students who have romantic relationships and those who spend long periods of time on the Internet."

Read more: BMC Public Health

Gay saunas are high risk HIV and STD hotspots in China

Gay Chinese men who find partners at gay saunas have a higher prevalence of HIV/syphilis when compared with those doing so via the Internet or gay bars, a study has found
Writing in the Journal of Sexual Medicine, researchers from Sun Yat-sen University, Guangzhou, say education and health campaigns targeted at saunas are urgently needed in order to reduce HIV and syphilis prevalence among gay men in China.
In their paper they say previous studies have suggested that the risk of HIV transmission among men who have sex with men (MSM) is associated with characteristics of venues. However, very few studies have systematically compared HIV/sexually transmitted disease (STD) prevalence among MSM according to key venue type for sourcing sex partners.
 Therefore they investigated  the associations between HIV/syphilis prevalence and the types of venues, namely saunas, parks, gay bars, and the Internet, which are mostly used for sourcing male sex partners by MSM in China.
They found that  the most commonly used sources to recruit male sex partners were the internet (59%) (gay bars (18.5%), gay saunas (14%) and parks (8%)). The prevalence of HIV/syphilis was 10.5%/19.4% for gay saunas, 2% /16% for parks, 6% /15.5% for internet partners and 4%/12%  for gay bars. The risk of infection was significantly higher when comparing partners  sourced in saunas compared to other ways such as internet.
Read more: Journal of Sexual Medicine

Is China failing its young people on sexual health?

by Frederika Whitehead
Awareness among the country's 161 million young people is poor, while sex education and services are said to be inadequate ...
China has a lot of work to do if it wants to provide adequate sexual health services for its 161 million 15- to 24-year-olds. A recent report funded by the United Nations Population Fund (UNFPA), found shockingly low levels of awareness about sexual health among its young people. Experts in the field have confirmed that the policies for providing these services either aren't in place or are not being enacted.
The UNFPA-funded report says that "at present there is no policy relating specifically to the sexual and reproductive health of youth in China".
And although it is mandatory for sex education to be taught in Chinese schools, some people working in sexual health say provision is woefully inadequate. "Chinese schools are supposed to teach sex education but they don't allocate enough time – they prefer to focus on academic subjects – they might give it only one hour, one session," says Wang Chen from the charity Prevention Through Education (PTE).
Lily Liu Liqing, country director for Marie Stopes International in China, agrees: "Officially it is available in middle schools [catering for 13-15 year-olds] but if you look closely the content is very limited, and it is centred around physical development. The sexes are usually taught separately. They will tell the boys about wet dreams and the girls about periods but they won't talk to them about contraception. They won't talk to them about the wider issues, they don't cover relationships, STIs [sexually transmitted infections], LGBT [lesbian, gay, bisexual and transgender] etc. It's just the mechanics. They do explain what HIV is but only in a very limited way."
Awareness of sexual health matters is very poor. Only 4.4% of the Chinese youth surveyed for the UNFPA report were able to answer all three of the following questions correctly: Can a woman get pregnant the first time she has sex? Masturbation causes serious damage to health – true or false? Abortion affects a woman's future pregnancies – true or false?
Despite mandatory emphasis on HIV in school sex education, the same survey also found ignorance about basic facts relating to HIV transmission. While 95% of youth had heard of HIV, when they were asked five questions such as: "Can a healthy-looking person have HIV?" or "Does using a condom reduce the risk of getting HIV?" only 14.4% of the young people polled answered them all correctly.
Another frequent complaint was about the lack of data collection. Few reliable national statistics are collected, charities say.
The national rates of teenage pregnancies, abortions, or STI infections are all unknown, which makes it difficult for agencies working with young people to ask for more assistance.
"Generally speaking we don't have reliable statistics," says Liu .
"This is the first thing we are really keen for the government to do," says Wang . "Young people are more interested in sex now than they were in the past. Abortions are very common. Many things seem to be on the increase but the data just isn't available."
Read more: Guardian