AbstractsMedical & Health Science

This thesis consists of a series of publications that address the emerging public health issues in the field of HIV/AIDS among men who have sex with men (MSM) in China. Men who have sex with men (MSM) in China are a population group particularly susceptible to HIV transmission and other sexually transmitted infections (STIs) but at the same time they are a hidden population due to social discrimination in Chinese society. The objectives of this thesis were to understand the past and current pattern of HIV epidemic and related risk behaviours of MSM, and estimate the HIV incidence among MSM in China through a modelling approach. This study first commenced with systematic reviews of all available Chinese and English literature and a series of meta-analyses to provide the best combined evidence on the trends of HIV epidemic and high-risk behavioural patterns in Chinese MSM. The second section of this study involved two empirical studies to investigate the HIV disease burden and behaviours among MSM particularly in a rural Chinese setting. Qualitative approach was used to explore the pattern and underlying causes of high-risk sexual practices and multiple sexual identities among MSM. Lastly, based on a mathematical model, this study examined the likelihood of HIV transmission (e.g. HIV incidence) through homosexual intercourses among MSM. As bisexual behaviour is also common among Chinese MSM, this model was then extended to examine HIV transmission to their female sex partners. This study represents an unprecedented and comprehensive integration of China’s HIV epidemiological and behavioural data. It provides strong evidence that HIV epidemic among MSM has been increased rapidly and became the dominant mode of HIV transmission in China. The HIV epidemic in China has clearly entered a new phase of transmission and will demand appropriate changes in its health policies and prevention strategies.