Syphilis social epidemiology in the People's Republic of China

描述（由申请人提供）：性传播感染（STI）合并梅毒和艾滋病毒的患者有一些最高的艾滋病毒传播概率，然而许多STI患者通常从未接受过这两种通常无症状的性传播感染的筛查。这份KOI申请详细说明了一个四年计划，重点是在华南地区实施梅毒/艾滋病综合服务，华南地区以梅毒高地方性传播和性传播艾滋病毒增加为特征。该研究和培训计划将临床流行病学和社会科学方法结合起来，由Myron S. Cohen博士（传染病）、陈祥生博士（流行病学）和Martin K. Whyte博士（社会学）指导。培训部分将包括临床流行病学、人类学和普通话方面的高级课程，以完成哈佛大学东亚区域研究硕士学位（MRSEA）。作为马萨诸塞州总医院的传染病研究员，我完成了一项初步研究，发现HIV与华南地区性病诊所的梅毒感染独立相关。性病诊所接受梅毒检测的比例大于90%，但接受艾滋病毒检测的比例较低。为应对华南地区不断扩大的梅毒疫情，世界卫生组织在两个城市启动了一项试点项目，在选定的性病诊所提供免费的快速梅毒检测，为并行的艾滋病毒业务研究提供了一个特殊的机会。在导师的支持下，我将过渡到麻省总医院的教职员工，我将专注于以下三个具体目标：1)分析与性病诊所接受艾滋病毒检测相关的性病患者特征；2)用定性方法描述性传播感染患者HIV检测的社会文化背景；3)评估与提供HIV检测相关的STI医生特征。拟议的培训和研究计划将为了解中国快速发展的性健康行为的复杂生物社会结构提供基础，使我成为一名初级研究员，对中国的梅毒和艾滋病毒双重流行实施新的行为反应。

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.