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Yang Wang

HIV/AIDS Research Progress and Prevention for Men Who Have Sex with Men (MSM) in China and the United States. Yang Wang. School of Biomedical Engineering, Sciences and Health Systems Department of Microbilogy and Immunology Drexel University School of Medicine.

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Yang Wang

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  1. HIV/AIDS Research Progress and Prevention for Men Who Have Sex with Men (MSM) in China and the United States Yang Wang School of Biomedical Engineering, Sciences and Health Systems Department of Microbilogy and Immunology Drexel University School of Medicine

  2. Epidemiology of HIV in United States In 2009, people living with HIV or AIDS in the world: 33.3 million. In US, by the end of 2010, 1,200,000 adults and children were estimated to be living with HIV. Among them, 17,774 died of HIV-related causes in 2009. UNAIDS Global AIDS Response Progress Reporting 2012 UNITED STATES OF AMERICA Country Progress Report

  3. Epidemiology of HIV in China In China, by the end of 2011, 780,000 adults and children were estimated to be living with HIV. Among them, 28,000 died of HIV-related causes in 2011. By August of 2010, cumulative number of PLHIV receiving ART was 100,000 in China.

  4. Research Progress on HIV Vaccine Until now, all the HIV vaccine trials are proven to be unsucsessful due to hyper-mutation and immune evasion of HIV failure of new HIV vaccine trial (HVTN505):a vaccine regimen consisting of a DNA vector encoding HIV-1 Gag, Pol, Nef and Env proteins followed by a recombinant adenovirus type 5 (rAd5)

  5. HAART is the name given to aggressive treatment regimens used to suppress HIV viral replication and the progression of HIV disease. The usual HAART regimen combines three or more different drugs such as two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI), two NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTI) or other such combinations. HIV Treatment- HARRT

  6. HIV Cure: After 2012, HIV cure gradually became a hotspot in HIV reseach. It commonly includes novel drugs, gene therapy, and bone marrow transplantation (BMT)CM Durand, et al., Nature, 2013 News, Nature, 2013

  7. Berlin Patient Timothy Brown, also known as “The Berlin Patient,” is thought to be the only individual functionally cured of HIV.

  8. In 2008, the US Centers for Disease Control and Prevention (CDC) estimated that at the end of 2006, approximately 1.1 million persons (prevalence rate 447.8 per 100 000 or 0.45%) were living with HIV in the United States. Of these, nearly half (48.1%) were MSM. • HIV Epidemic among MSM in US Centers for Disease Control and Prevention. HIV prevalence estimates: United States, 2006. MMWR 2008;

  9. HIV Epidemic among MSM in US (cont.) 1. HIV prevalence varies extensively, with the highest prevalence figures observed for low socioeconomic status men, African Americans, injection drug users, and heavy non-injection substance users 2. HIV prevalence was higher among MSM in their 40s, those who were fully out, and more strictly homosexual men or men who self-identified as gay. Joseph A. Catania et al. American Journal of Public Health, 2001

  10. HIV Epidemic among MSM in US (cont.) 3. New York City and Los Angeles contain the 2 largest MSM communities in the United States, Chicago contains a focal community for MSM in the northern Midwest, and San Francisco has the highest-density MSM neighborhoods of any US city. These 4 cities alone hold more than one third of all MSM AIDS cases in the United States. Furthermore, these cities also are common vacation destinations for many MSM and thus may provide geographic foci from which HIV infection may spread to other areas of the country.

  11. HIV Epidemic among MSM in US (cont.) 4. Overall, the estimated HIV incidence among black MSM was 8.0 times higher than among white MSM. Of new infections in MSM, 46% were in whites, 35% were I n african americans and 19% were in Hispanics. 5. When many MSM saw close friends, partners and lovers die—gay communities adopted a range of practices to reduce the risk of infection successfully by changing sexual behaviours. Regretfully, these achievements did not last; many other developed countries also recorded a resurgence in the number of MSM newly diagnosed with HIV/AIDS since the mid-1990s. The main reason for the re-emergence of the disease was the come-back of risky sexual behaviours, triggered by wider social and cultural changes, greater social acceptance for gay men and, somehow unpredictably, the introduction of more efficient drugs 

  12. 6. Another main factor for the resurgence of AIDS among the gay communities in US is, ironically, the efficiency of HAART—AIDS Fatigue. 7. the rise of internet-dating sites has increased the ease with which new partners can be found—to facilitate HIV infection among MSM.

  13. HIV Epidemic among MSM in China 1. In mainland China, several recent cross-sectional studies among MSM show HIV prevalence ranging from 0.5% in Jinan to 8.5% in Chongqing and 9.1% in Chengdu (prevalence greater than 10% in several southwest cities). The mean infection rate among MSM is 5.0% in China(2.0% in US).

  14. HIV Epidemic among MSM in China(cont.) 2. Some sociologists found that 7.0% male college students had homosexual inclination (scholars in China often put bisexuals into homosexuals) . Suprisingly, college male students that commonly are thought to be low prevalence for HIV have become high-risk population for HIV infection 3. In recent years, older gay men account for more and more HIV infection.

  15. HIV Epidemic among MSM in China(cont.) 4. Owing to being Restricted by political, cultural and custom elements, China is lagging behind in study on relationship between MSM and HIV/AIDS, and lacking involved data and corresponding health interventions as well

  16. HIV Epidemic among MSM in China(cont.) 5. Due to ingrained perception of marrige and childbearing, MSM in China present different chacteristic compared with MSM in US. As for China, 70-80% of welleducated gays or bisexuals in metropolitan areas has or will get married with women. The proportion in rural areas may climb to 90% and marriage with women usually becomes inevitable because the incoming severe societal pressure if they do not get married. This suggests that MSM could also potentially act as a bridge to transmit HIV to the general female population. MSM in developed nations scarcely had sex or get married with women and the spread is confined to MSM community

  17. HIV Epidemic among MSM in China(cont.) 6. There are 56 ethnicities in China, the majority of which is the Han ethnicity (91.5%), and Chinese ethnic minority MSM are considered to be a high-risk subpopulation of MSM. MSM in Kunming, Yunnan Province found that the incidence of HIV among minority MSM was 10.1/100 PYs, which was significantly higher than Han-ethnic MSM (2.3/100 PYs). Additionally, minority MSM are also at risk of spreading HIV to the general population. Ethnic minority MSM were more likely to have sex with women compared to MSM who are of Han ethnicity. HIV prevention and behavioral intervention programs should focus their efforts on targeting these subpopulations of student and minority MSM.

  18. HIV Epidemic among MSM in China(cont.) 7. There are many new factors that can significantly increase the rate of HIV transmission among men who have sex with men (MSM), including low HIV testing rates, high HIV incidence, high prevalence of syphilis infection and migration. The newly emerging HIV epidemic among MSM has been fueled by several factors, including low HIV testing rates, high prevalence of syphilis, persistent stigma against homosexuality and traditional concepts toward marriage and childbearing

  19. HIV Epidemic among MSM in China(cont.) 8. Low HIV testing rates and high rates of high-risk sexual behaviors are major factors that correlate with the HIV epidemic among MSM. The effect of traditional Chinese culture is another major factor that iscorrelated with the HIV epidemic among MSM in China.

  20. Prophylaxis for HIV among MSM 1. Efforts should be made to reduce stigma toward MSM. Stigma and discrimination toward MSM within families and in the wider community remains enormous and has become the major barrier for MSM access to AIDS programs. 2. Carry out HIV test among MSM periodically and establish more sentinel surveillance sites to track HIV progression The number of sentinel surveillance sites focused on this group has increased from 3 sites in 2005 to 9 sites in 2007 to 56 sites in 2009. The percentage of MSM tested for HIV who knew their result increased from 32.7% in 2007 to 44.9% in 2009 in China

  21. Prophylaxis for HIV among MSM As trategic plan and guidelines for conducting interventions among MSM were developed in 2006 with substantial input from MSM community leaders. These programs reached anaverage of 85,727 MSM per month in 2009 and the percentage of MSM who had used a condom during their last sexual encounter increased from 64.4% in2007 to 73.1% in 2009

  22. Prophylaxis for HIV among MSM 3. NGO for MSM should be given more freedom and less control by government to better facilitate HIV prevention among MSM. 4. condom promotion among HIV positive MSM is another effective strategy to prevent HIV transmission, especially because it is very inexpensive compared with administering early ART. 5. expand media, education, and HIV testing programs among MSM Compared with early HIV treatment strategies.

  23. Looking at What does Scientists Say

  24. Conclusion • HIV has become a chronic infectious disease due to HARRT adoption. However, HIV vaccines are not developed sucssesfully. • MSM community is still the high-risk population in transmitting HIV. HIV epidemic among MSM between US and China not only share a variety of similarities, but also differnces due to cultural difference and political system. • 3. in terms of HIV prevention among MSM community, corresponding measures should be adopted for prophylaxis

  25. School of Publich Health, Drexel University: Randel Sell, Ph.D,C MPH William Way LGBT Community Center in Philadelphia : Chris Bartlett, Director Avis, Staff China CDC: Yiming Shao, M.D, Ph.D Guodong Mi, M.D, Ph.D Sex Health Center of the Affiliated Hospital of Medical College Qingdao University, China: Beichuan Zhang, M.D “Tongai” Gay Center, China Xiaohan Xiang, Director “Tongzhiyifanren” Gay Center, China Hui Du, Coordinate Director Acknowledgement

  26. Pray for passengers aboard Malaysia Airlines flight MH370 153 Chinese and 38 Malaysians disappeared!!!

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