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BACKGROUND: Many Burmese women have migrated to Yunnan Province and married local residents over the past few decades; however, limited information is available on their HIV prevalence and ability to cope with HIV. This study aims to assess the prevalence of HIV and knowledge related to AIDS, as well as to discover possible risk factors of HIV infection among foreign brides from Burma in Yunnan Province. METHODS: A cross-sectional study was taken of all Burmese cross-border wives residing in Tengchong County using standardized questionnaires. HIV and syphilis testing was conducted at the same time. RESULTS: Among 600 Burmese brides, the HIV prevalence was 2.17%. Those aged 21-30, those with higher education levels and those who had resided in China less than one year had higher infection rates. The AIDS awareness rate of 39.50% was very low in this population. Only 28.67% of participants had ever been involved in prevention services. The rate of condom use was low. Classification by age, education, occupation, prior HIV testing and prior use of HIV prevention services showed a statistically significant association with mean knowledge score (p < 0.05). Residing in China less than one year (OR = 3.86, 95% CI = 1.09-13.70) and having casual sex in the last year (OR = 10.49, 95% CI = 1.20-91.59) were risk factors for HIV infection. CONCLUSIONS: Burmese brides in China are not only exposed to a high risk of HIV infection, but also seriously lack response capabilities. Educational interventions and control efforts are practical approaches that need to be strengthened among this population.

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OBJECTIVE: To understand the knowledge, risk behaviors and HIV prevalence in men who have sex with men (MSM) in thirteen cities. METHODS: Target samples were chosen using the snowball-rolling method, with transverse KABP and HIV-antibody testing developed for those MSM in thirteen cities of Yunnan. RESULTS: A total of 1237 valid questionnaires and 1129 blood samples were collected. Basic knowledge on HIV and the rate of the response was 93.2%. 81.1% of the respondents had anal sex with male partners in the last six months, of them 49.7% could persistently using condoms in each anal sex episode. 29.0% of the respondents had sex with female partners in the last six months. The HIV prevalence among the studied MSM was 8.2% and the prevalence of syphilis among them was 3.9%. Most risky factors of those MSM infected by HIV would include: not persistently use condom when having sex and co-infection of syphilis. CONCLUSION: Both rates of HIV infection associated risk behaviors and HIV prevalence were high in MSM under study that called for more work on HIV prevention and control MSM in Yunnan.

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OBJECTIVE: To investigate the distribution of HIV-1 subtypes in Dehong prefecture, Yunnan province, in 2011. METHODS: 300 HIV-1 positive plasma samples were collected from Jan. 2011 to May 2011 in Dehong prefecture. HIV-1 gag genes and env genes were amplified by nested-polymerase chain reaction (PCR) from viral RNA. After sequencing, the HIV-1 subtypes were determined by phylogenetic analysis. RESULTS: Based on the phylogenetic trees of gag gene and env gene fragments, a total of 222 samples were genotyped. Subtype C was the predominant strain in Dehong (43.2%, 96/222), followed by unique recombinant forms (URFs, 27.0%, 60/222), CRF01_AE (21.2%, 47/222), CRF08_BC (5.0%, 11/222), B' (2.3%, 5/222) and CRF07_BC (1.4%, 3/222). Subtype C strains were predominant in both heterosexually transmitted population and intravenous drug users (IDUs), but different subtype distribution patterns were found in these two populations. All 6 genotypes including subtype C (40.7%, 70/172), CRF01_AE (25.0%, 43/172), and URFs (25.0%, 43/172) found in this area among heterosexually transmitted population, which showed the diversity of genotypes in this population. Except subtype B' and CRF07_BC, the other 3 subtypes and URFs were detected among IDUs, mainly including subtype C (54.8%, 23/42) and URFs (38.1%, 16/42), which showed the concentration trend of genotypes distribution among IDUs. The proportion of URFs increased significantly in this area, including the new BC recombinants (41.7%, 25/60) and CRF01_AE relative URFs (58.3%, 35/60). However, the distributions of these two URFs among heterosexually transmitted population and IDUs showed no statistical significance. CONCLUSION: The distribution of HIV-1 strains prevailing in Dehong prefecture was diversity, including 5 subtypes and a variety of URFs, of which subtype C was the predominant strain. The distribution patterns of subtype were different among different populations.

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OBJECTIVE: To determine the incidence and risk factors on HIV infection among injection drug users (IDU) in Dehong prefecture area of Yunnan province. METHODS: An epidemiological cohort of HIV-negative IDU had been developed and followed since October, 2004. HIV new infections and related behaviors had been investigated every six months. RESULTS: By the end of 2008, 760 HIV-negative IDU had been recruited and followed for a total of 1153.6 person-years. 47 new HIV infections were identified, with an overall incidence of 4.07/100 person-years during the follow-up period. The HIV incidence was 4.45/100 person-years during 2004 - 2006, 4.50/100 person-years in 2007 and 2.54/100 person-years in 2008. Both the behavior of drug injection and the HIV incidence among the cohort had substantially decreased during the follow-up period. Multiple regression analysis using Cox proportional hazard model indicated that people with Jing-po ethnicity (Hazard ratio, HR = 2.56, 95%CI: 1.06 - 6.19) and other minorities except for Dai (HR = 3.26, 95%CI: 0.89 - 11.96) were at higher risk for HIV infection than the people with Han ethnicity. People injecting drugs with (HR = 2.27, 95%CI: 0.98 - 5.25) or without (HR = 5.27, 95%CI: 2.25 - 12.34) needle sharing were at higher risk for HIV infection than those reporting having no drug injection behavior during the follow-up period. CONCLUSION: Both the behavior of drug injection and the HIV incidence among former IDU in Dehong prefecture area of Yunnan province had been decreasing during the four years. However, needle sharing remained the most important risk factor for HIV new infection among IDUs. IDUs with different ethnicities seemed to have different risks towards HIV infection.

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OBJECTIVE: To understand epidemiologic characteristics and changes in epidemic trend of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) in different areas and populations of Yunnan Province. METHODS: Seroepidemiological studies were conducted in injection drug users (IDUs), women sex workers, whoring goers, patients with sexually transmitted disease (STD), patients with tuberculosis, pregnant women and blood donors with sentinel surveillance, ad hoc investigations, regular case-finding and data collection during 1989 to 2003 in Yunnan Province. RESULTS: Relatively high prevalence of HIV/AIDS was firstly found in IDUs from border areas of the province in 1989. By December of 2003, totally 14 905 cases with HIV infection were reported in 121 counties of 16 prefectures in Yunnan Province. Prevalence of HIV infection ranged from 21.2% to 27.8% in IDUs, over 40% in IDUs from six areas, and 1.23% to 6.67% and 0.3% to 1.8% in underground prostitutes and whoring goers, respectively. Prevalence of HIV infection was 2.1% to 2.7%, 10.8% in specific areas, in male patients with STD, and was 0.14% to 0.25% in pregnant women during 1993 to 2002 and increased to 0.37% in 2003. Prevalence of HIV infection ranged 1.5% to 1.6% in patients with tuberculosis and 0.01% in blood donors during 1999 to 2000 and increased to 0.07% in 2003. CONCLUSIONS: Epidemic of HIV infection began in late 1980s in Yunnan, then spread from border areas to inland through IDUs, maintaining a higher prevalence in them to date. Sexual transmission of HIV/AIDS showed an increasing trend in them, with a low prevalence in general population, but appeared a wide spread in local areas.

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