| Background:Sexual transmission has become the main transmission route of HIV epidemic in China,and the proportion of heterosexual transmission has been increasing annually.The predominant route of heterosexual transmission is non-marital heterosexual transmission,including transmission through commercial heterosexual contact(CHC)and non-marital non-commercial heterosexual contact(NMNCHC).Ever since 2015,the frequency of newly identified People living with HIV/AIDS(PLWHA)transmitted through NMNCHC has been increasing,indicating that the HIV epidemic in China has spread from high-risk population to the general population,which has brought a new challenge for HIV/AIDS prevention and control in China.However,there are few reports on the epidemic characteristics,variation tendency,etiological characteristics and transmission network of non-marital and non-commercial heterosexual transmission.A clear grasp of the current situation and development pattern of HIV transmission through NMNCHC is conducive to the effective prevention and control of HIV/AIDS in China.Hence,this study combined epidemiological and molecular epidemiological methods,comprehensively analyzed the epidemic characteristics and molecular transmission network of PLWHA transmitted through NMNCHC in China from the perspective of epidemiology and etiology.Objectives:From the perspectives of epidemiology,etiology and molecular epidemiology,this study comprehensively analyzed the epidemiological characteristics,etiological characteristics,molecular transmission network and the possible transmission relationship between high-risk populations and PLWHA transmitted through NMNCHC,so as to enrich the cognition of the epidemiological characteristics of PLWHA transmitted through NMNCHC.It is expected to provide a valuable foundation for the improvement and innovation of HIV/AIDS prevention and control strategies in China.Content and Methods:The first part of this study is based on the data in Chinese HIV/AIDS Comprehensive Response Information Management System(CRIMS)from 2015 to 2018,using descriptive epidemiological methods to analyze the epidemic characteristics of more than 520,000 newly reported PLWHA in China.The epidemiological characteristics of PLWHA transmitted through NMNCHC in China were analyzed by descriptive epidemiological methods.Multivariate logistic regression analysis and spatial analysis were applied to compare and analyze the socio-demographic characteristics and spatial distribution hotspots of PLWHA transmitted through NMNCHC.In the mean time,we also explored the multiple contact history related to the non-marital and non-commercial heterosexual contact history of PLWHA.In the second part of this study,a field epidemiological survey was conducted on 328 newly identified PLWHA transmitted through NMNCHC in nine districts and counties of Zhejiang Province from 2017 to 2019,and the HIV gene sequence information of 198(60.37%)respondents was successfully obtained.The sexual partner types,sexual behavior characteristics,molecular subtypes and molecular transmission network characteristics of the subjects were analyzed.The third part of this study was based on the analysis of the second part,which explored the HIV subtypes and molecular transmission networks of 803 newly reported PLWHA(74.42%)from 2017 to 2019 in Jiaxing City,Zhejiang Province,using molecular transmission network analysis.To explore the relationship between PLWHA transmitted through NMNCHC and those transmitted through other routes within molecular transmission network.Results:The results of the epidemiological analysis nationwide exhibited that the proportion of PLWHA transmitted through NMNCHC increased from 46.33%(2015)to 49.02%(2018).Among non-marital heterosexual transmission,males were more likely to report as transmitted through CHC,while females were more likely to report as transmitted through NMNCHC.There was a significant increase in the frequency of newly identified PLWHA transmitted through CHC among people over 65 years of age,in contrast,younger people were more likely to be reported as transmitted through NMNCHC.The distribution of hot spots of PLWHA transmitted through NMNCHC and CHC overlapped to a large extent nationwide.In those who reported non-marital and non-commercial heterosexual contact history among the PLWHA with multiple contact history,the proportion of PLWHA who reported having both contact history of NMNCHC and CHC was the highest(53.48%),suggesting that the cross-channel transmission of these two types of transmission routes may be the highest.This was followed by PLWHA who reported having both contact history of NMNCHC and male-to-male sex(24.98%).The results of etiological analysis and field survey showed that there were various sexual partner types and sexual behavior characteristics of PLWHA transmitted through NMNCHC,with the proportion of having temporary partner only,having fixed partner only and having both types of sexual partner accounting for 35.98%,53.35%and 10.67%,respectively.Moreover,PLWHA transmitted through NMNCHC often have unprotected sex and the proportion of using condoms during every sexual behavior is extremely low.The proportion of condom use during each sexual behavior was 8.33%and 2.48%for temporary partners and fixed partners among males,4.44%and 0%for temporary partners and fixed partners among females.The low condom use rate may be an important reason for the increasing number of PLWHA transmitted through NMNCHC in China.In this study,16 different subtypes of HIV were found within PLWHA transmitted through NMNCHC,suggesting that the epidemic of HIV among this population is complex and may be caused by cross-channel transmission of high-risk groups.In the molecular transmission network of PLWHA transmitted through NMNCHC,CRF01?AE and CRF07?BC subtypes formed the most clusters,but the overall clustering rate was low and all of them were scattered clusters,suggesting that the distribution of the transmission network in this population was scattered and the correlation degree of internal transmission was low,which indicated that they may be closely related to the transmission of high-risk population.The molecular transmission network analysis showed that CRF01?AE and CRF07?BC subtypes were the main transmission subtypes in PLWHA transmitted through NMNCHC and other transmission routes in Jiaxing.The proportion of CRF08 BC subtype in PLWHA transmitted through NMNCHC and CHC was 18.22%and 21.31%,respectively,while the proportion of this subtype in PLWHA transmitted through men who have sex with men(MSM)was only 0.32%.The CRF55?01b subtype accounted for 5.7%in PLWHA transmitted through MSM,while only 1.69%in PLWHA transmitted through NMNCHC.A molecular transmission network was constructed for all the 803 PLWHA in Jiaxing City under the 1%genetic distance threshold.A total of 332 patients were included in the transmission network,the clustering rate was 41.34%,and the number of clusters was 97.The largest cluster in the transmission network included 63 PLWHA patients.The clustering rates of CRF07?BC and CRF01 AE subtypes were the highest of all,which were 46.02%and 40.21%,respectively.The number of clusters of CRF01?AE was higher than that of CRF07 BC,while the cluster density of CRF07 BC was higher than that of CRF01?AE.Quantitative analysis was conducted on the correlation between PLWHA transmitted through NMNCHC and other routes in molecular transmission network.The results indicated that the proportions of weighted correlation of PLWHA transmitted through NMNCHC and PLWHA transmitted through CHC or MSM were 26.72%and 26.16%,respectively.In addition,the proportion of weighted correlation between PLWHA transmitted through MSM and NMNCHC was 19.48%,while the proportion of weighted correlation between PLWHA transmitted through CHC and NMNCHC was 31.32%.Conclusions:Non-marital and non-commercial heterosexual transmission has become one of the main routes of HIV transmission in China.Among PLWHA transmitted through heterosexual transmission,the primary route of transmission is CHC in males and NMNCHC in females.In those who reported non-marital and non-commercial heterosexual contact history among the PLWHA with multiple contact history,the proportion of PLWHA who reported having both contact history of NMNCHC and CHC was the highest.PLWHA transmitted through NMNCHC has different sexual partner types and sexual behavior characteristics,and the condom utilization rate is low.The internal transmission network of PLWHA transmitted through NMNCHC is scattered and their transmission network is intertwined with PLWHA transmitted through high-risk routes,and PLWHA transmitted through NMNCHC is closely related to PLWHA transmitted through CHC or MSM.Therefore,it is necessary to conduct in-depth research and precise prevention and control of bridge population who caused the cross-channel transmission. |
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