Ustainable supplies and continue to strengthen the physician education program initiated
Ustainable supplies and continue to strengthen the physician education program initiated in 2002. With the expansion of ART coverage, first line drug resistance and second line treatment availability will become bigger concerns. ART resistance testing and surveillance are currently being conducted and will expand to nationwide coverage within the next 5 years. NCAIDS is also considering greater cooperation with nongovernmental organizations (NGOs) as a channel for providing additional adherence counseling. As treated patients live longer, long term ART-related side effects like the above-mentioned mitochondrial toxicities will GW9662MedChemExpress GW9662 require improved monitoring and management. Finally, efforts are needed to reduce stigma, which prevents many from receiving HIV testing and treatment. Infection withHIV is often equated with being immoral – it is not uncommon for HIV-positive individuals to be estranged from their family, and the family from the community, all driven by fear and shame. The Chinese government is already taking steps to promote social tolerance by expanding methadone maintenance treatment (MMT) and needle and syringe programs (NSPs), removing the requirement for viral hepatitis testing before school and job entry, and lifting the entry ban on HIV-positive foreigner [84]. Substantial progress has been made in the area of harm reduction, especially among IDUs. In 2006, the Ministry of Health, Ministry of Public Security and the State Food and Drug Administration (SFDA) issued the revised “Opium Abusers Community-Based Drug Maintenance Treatment Protocol,” which expanded the MMT program from pilot phase to general application. By the end of 2008, 558 MMT clinics in 23 provinces have served more than 170,000 clients [85]. PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28993237 NSPs have expanded to a total of 790 centers, about half of which were funded by the government as of 2006 [86]. The US NIH also supports an HIV prevention trial among HIV-negative IDUs in the provinces of Guangxi and PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27486068 Xinjiang. However, major hurdles remain among other risk groups. Sexual transmission has become the fastest growing means of HIV transmission in China due to changing sexual behavior and attitude since China opened up to the outside world in the late 1970s [87]. Among new HIV cases in China in 2007, close to 45 are infected through heterosexual transmission, with the majority being transmission between non-regular partners [88], including female sex workers (FSW) and their clients. In one study, 60 of FSWs in China did not use condoms consistently with their clients [88]. Considerable crossover exists between risk groups, especially among commercial sex workers and IDUs, creating a bridging effect of spreading HIV from IDUs to the clients and regular sex partners of FSWs [89]. While accounting for only about 2-5 of all adult males [90], men who have sex with men (MSM) represent an estimated 12 and rapidly growing proportion of all HIV-positive persons in China [88,91]. The Chinese MSM population is another important bridge for the spread of HIV, as one-half report having sex with women, and one-third being married. Research and intervention among MSM have received increased funding and attention from both the Chinese government and international organizations [92,93]. Since most available studies were conducted in large or medium-sized cities among the well educated, additional research is needed especially in rural areas and among military personnel, prisoners, college students, and migrant workers.