Syphilis social epidemiology in the People's Republic of China

描述（由申请人提供）：性传播感染（STI）患者合并感染梅毒和艾滋病毒有一些最高的艾滋病毒传播概率，但许多STI患者往往从来没有接受过这些经常无症状的STI筛查。该KOI申请详细介绍了一项四年计划，重点是在中国南方实施梅毒/艾滋病毒综合服务，该地区的特点是高度地方性梅毒传播和艾滋病毒性传播增加。将临床流行病学和社会科学方法联系起来，研究和培训计划将由Myron S. Cohen（传染病）、Xiang-Sheng Chen博士（流行病学）和Martin K.怀特（社会学）。培训内容将包括临床流行病学、人类学和汉语普通话的高级课程，以完成哈佛东亚区域研究硕士学位。作为马萨诸塞州总医院的一名传染病研究员，我完成了一项初步研究，发现艾滋病毒与中国南方性病诊所的梅毒感染独立相关。性传播感染诊所的梅毒检测接受率超过90%，但艾滋病毒检测接受率很低。为了应对中国南方不断扩大的梅毒流行，世卫组织在两个城市启动了一项试点计划，在选定的性病诊所提供免费的快速梅毒检测，为平行的艾滋病毒业务研究提供了特殊机会。在导师的支持下，我将过渡到马萨诸塞州总医院的教师，我将专注于以下三个具体目标：1）分析性病患者的特征，相关接受艾滋病毒检测在性病诊所; 2）描述艾滋病毒检测性病患者使用定性方法的社会和文化背景; 3）评估性病医生的特征，相关提供艾滋病毒检测。拟议的培训和研究计划将提供一个基础，以了解在中国迅速发展的性健康行为的复杂的生物社会结构，独特定位我作为一个初级研究员实施新的行为反应梅毒和艾滋病毒在中国的孪生流行病。

DESCRIPTION (provided by applicant): Sexually transmitted infection (STI) patients co-infected with syphilis and HIV have some of the highest HIV transmission probabilities, yet many STI patients often never receive screening for either of these frequently asymptomatic STIs. This KOI application details a four year plan focused on implementing integrated syphilis/HIV services in South China, a region characterized by hyper endemic syphilis transmission and increasing sexual HIV transmission. Linking clinical epidemiology and social science methods, the research and training plan will be mentored by Dr. Myron S. Cohen (Infectious Diseases), Dr. Xiang-Sheng Chen (Epidemiology), and Dr. Martin K. Whyte (Sociology). The training component will include advanced coursework on clinical epidemiology, anthropology, and Mandarin Chinese to complete a Masters in Regional Studies East Asia (MRSEA) at Harvard. As an Infectious Disease Fellow at the Massachusetts General Hospital, I completed a preliminary study that found HIV to be independently associated with syphilis infection at STI clinics in South China. Syphilis test acceptance at STI clinics was greater than 90%, but HIV testing acceptance was poor. Responding to South China's expanding syphilis epidemic, the WHO has launched a pilot program in two cities providing free rapid syphilis testing at select STI clinics, introducing a special opportunity for parallel HIV operational research. Transitioning to the Massachusetts General Hospital faculty with my mentor's support, I will focus on the following three specific aims: 1) To analyze STI patient characteristics that correlate to accepting HIV testing at STI clinics; 2) To describe the social and cultural context of HIV testing STI patients using qualitative methods; 3) To assess STI physician characteristics that correlate to offering HIV testing. The proposed training and research program will provide a foundation to understand the complex biosocial fabric of rapidly evolving sexual health behaviors in China, uniquely positioning me as a junior investigator to implement novel behavioral responses to the twin epidemics of syphilis and HIV in China.