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Unprotected Sex Among HIV-Positive Treatment-Seeking Opioid-Dependent Adults in China: A Cross-Sectional Study

Zhang, Zhenghong MD, MS; Wu, Zunyou MD, PhD; Poundstone, Katharine E. MHS; Yin, Wenyuan MD, MS; Pang, Lin MD, MS; Rou, Keming BS; Luo, Wei MD, PhD; Cao, Xiaobin MD, PhD; Wang, Changhe MD, PhDChina’s National Working Group on Methadone Maintenance Treatment

doi: 10.1097/OLQ.0b013e318272c497
Original Study

Background We set out to identify factors associated with unprotected sex among HIV-positive patients on methadone maintenance therapy (MMT) in China.

Methods We conducted a cross-sectional study in 60 MMT clinics in Yunnan, Sichuan, Guizhou, Guangxi, and Xinjiang provinces, China, with a total of 2742 participants.

Results The median age of participants was 35 years (range, 19–63 years), and 78.3% were male. More than half (1471/2742; 53.6%) were married, 6.4% (176/2742) had a regular sex partner, and 3.5% (95/2742) had 1 or more occasional sex partners. Among married participants, 64.6% (950/1471) had a spouse who was HIV negative or of unknown HIV status. Among them, 62.8% (597/950) reported sex in the past 30 days, and 31.0% (185/597) reported unprotected sex in the past 30 days. Multivariate logistic regression identified 3 factors associated with an increased risk of unprotected sex: receiving MMT in Guangxi (odds ratio [OR], 3.72 [2.05–6.75]; P < 0.001) or Xinjiang (OR, 2.23 [1.33–3.73]; P < 0.01), having a spouse that is a current or former drug user (OR, 1.80 [1.12–2.90]; P < 0.05), and having dropped out of MMT in the past 6 months (OR, 3.05 [1.63–5.71]; P < 0.001); it also identified 2 factors associated with a decreased risk of unprotected sex: being male (OR, 0.46 [0.26–0.79]; P < 0.01) and being aware of one’s own HIV serostatus (OR, 0.16 [0.10–0.27]; P < 0.001).

Conclusions Many HIV-positive opioid-dependent individuals attending MMT continue to engage in high-risk sexual behaviors. Future efforts should focus on increasing awareness of HIV serostatus, retaining patients in MMT, and addressing the specific needs of female patients on MMT.

A study of HIV-positive patients on methadone in 5 provinces in China found high levels of unprotected sex, even among those in HIV-serodiscordant partnerships.

From the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

The authors thank the study group including the staff in Yunnan Center for Disease Control and Prevention (CDC), Sichuan CDC, Guizhou CDC, Guangxi CDC, Xinjiang CDC, and at 60 methadone maintenance therapy clinics for their help with data collection; Hongchun Wang and others (sexually transmitted disease center, China CDC); Jianhua Li and others (Institute of Drug Abuse, Yunnan province); and the staff at CDC laboratories in 5 provinces.

Supported by the Chinese Government National Science and Technology Major Project on HIV/AIDS and Hepatitis and Other Major Infectious Diseases in the 11th Five-Year Plan of China (Grant No. 2008ZX10001-016). The funding agency had no role in the study design, data collection, or analysis and interpretation of the results, and this study does not necessarily reflect the views or opinions of the funding agency.

Correspondence: Zunyou Wu, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China. E-mail:

Received for publication March 8, 2012, and accepted August 9, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association