Curbing the Rapid Spread of HIV Among MSM in China

To the Editors: We welcome the additional analyses performed by Chow et al.1 Our own estimates from 2009 suggested that the men who have sex with men (MSM) population in Kunming numbered roughly 25,600 (20,000-30,000) with 8.83%-11.78% HIV positive [n = 2646 (2000-3000)]. Sex between men accounted for 38% of HIV infections caused by sexual contact and 19% of all HIV infections in Kunming. Using the BED-assay,2 we estimated that the number of new HIV infections among MSM was about 1200 in 2008 and 1500 in 2009. Increasing HIV prevalence among MSM has been seen nationwide, and data from our national sentinel surveillance system have indicated the proportion of HIV-positive MSM increased from 7.3% in 20053 to 12.2% in 20074 to 32.5% in 2009.5 Although the incidence of HIV does seem to be increasing, based on the projections made by Chow et al, we believe this trend will not continue unabated due to ceiling effects and the much greater size of the heterosexual population compared with the MSM population in Kunming. However, we do agree that a considerable proportion of HIV-infected MSM remain undiagnosed and will make an important contribution to the HIV epidemic in the MSM community.6 Therefore, increasing accessibility and utilization of testing services by MSM is a top priority. Chow et al have made a number of recommendations for future health interventions, and we are pleased to report that many of these recommendations are already moving forward nationwide as follows: (1) MSM have been included among high-risk groups by the Ministry of Health since 2006.7 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 2009.8 Efforts have been made to reduce stigma toward MSM among health professionals, including a national consultation meeting jointly attended by public health officials and by MSM community leaders to help health workers understand MSM communities, and how they can work for them and with them. 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. Further and multisectoral efforts are needed to achieve wide-scale reduction or elimination of stigma in society. As yet no law exists specifically protecting the rights of MSM, although laws do exist protecting the rights of people living with HIV/AIDS9 and homosexuality is not illegal in China. (2) A strategic plan and guidelines for conducting interventions among MSM were developed in 2006 with substantial input from MSM community leaders. Various programs have been conducted, including condom promotion, counselling and testing, peer education, sexually transmitted infection services and follow-up, and outreach.4 These programs reached an average 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% in 2007 to 73.1% in 2009.8 (3) As noted by Chow et al, marginalized populations tend to shy away from government programs, so the involvement of community-based organizations is crucial. Although such organizations still face considerably barriers in China,10 they are playing a major role in HIV prevention efforts among MSM, both independently and in cooperation with government agencies. Manhong Jia, MD* Sheena G. Sullivan, MPH† Lin Lu, MD* Zunyou Wu, MD, PhD† *Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China †National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China