樱花视频

Skip to main content
Download PDF
  • Research
  • Published:

Analysis of HIV-1 recent infections and hotspot areas in a bordering area in Yunnan Province, China

樱花视频 volume听25, Article听number:听1122 (2025) Cite this article

Abstract

Background

Honghe Prefecture, located on the China-Vietnam border, has long suffered from HIV-1. To accurately assess the HIV-1 prevalence situation and promote precise prevention and treatment of AIDS, a recent infection surveillance was conducted to explore the at-risk subpopulations and hotspot areas of HIV-1 transmission in Honghe Prefecture.

Methods

Combined with the recent infection testing algorithm, HIV-1 recency assay was used to differentiate recent HIV-1 infections among newly reported HIV-1 cases in Honghe Prefecture from 2021 to 2022. Factors associated with recent HIV-1 infection were analyzed by logistic regression. The hotspot areas of recent infections were analyzed by spatial scanning statistics.

Results

Of the 2698 HIV-1-infected individuals enrolled in this study (no HIV-2 cases reported), 297 HIV-1 cases were classified as recent HIV-1 infection, and the proportion of recent infection was 11.0%. Females (AOR鈥�=鈥�2.61, 95% CI: 1.98鈥�3.43), young people (15鈥�34 years old) (AOR鈥�=鈥�1.71, 95% CI: 1.21鈥�2.43), highly educated people (AOR鈥�=鈥�2.04, 95% CI: 1.24鈥�3.37), men who have sex with men (MSM) (AOR鈥�=鈥�3.08, 95% CI: 1.74鈥�5.46), and spouses/regular sexual partners of HIV-1-positive individuals (AOR鈥�=鈥�1.96, 95% CI: 1.15鈥�3.33) were more likely to be detected as recent infections. Among the subpopulations by sex, age and transmission route, heterosexually exposed women aged 15鈥�34 years (OR鈥�=鈥�1.85, 95% CI: 1.07鈥�3.19) and 35鈥�49 years (OR鈥�=鈥�1.65, 95% CI: 1.05鈥�2.58) and MSM aged 15鈥�34 years (OR鈥�=鈥�5.11, 95% CI: 2.73鈥�9.59) had a higher proportion of recent infections. Among the subpopulations by mode of exposure and sex, men infected through homosexual contact (OR鈥�=鈥�5.59, 95% CI: 3.30鈥�9.47) and women infected through non-marital non-commercial heterosexual contact (OR鈥�=鈥�2.10, 95% CI: 1.50鈥�2.95) and positive spousal exposure (OR鈥�=鈥�3.03, 95% CI: 1.96鈥�4.69) had a higher proportion of recent infections. With regard to detection methods, women detected by provider-initiated HIV testing counseling (PITC) (OR鈥�=鈥�2.03, 95% CI: 1.50鈥�2.76) and spouse/sexual partner testing (OR鈥�=鈥�4.10, 95% CI: 2.19鈥�7.67) had a higher proportion of recent infections. A statistically significant spatial cluster of recent infections was found in one county, Yuanyang.

Conclusions

This study investigated the use of HIV-1 recency testing in combination with HIV-1 case report surveillance. Correlation factor analysis revealed the presence of distinct risk subpopulations. The spatial distribution of recent infections showed differences. These findings were important for assessing the transmission risk and developing the targeted measures for interventions.

Clinical trial number

Not applicable.

Peer Review reports

Introduction

Despite global efforts, it is still challenge to achieve the target of reducing new HIV infections to 335,000 by 2030 [1, 2]. HIV-infected individuals are particularly infectious during the early stages of infection (acute and recent HIV infection). Research indicates that half of all HIV transmissions occur during these early stages, highlighting the importance of identifying recent infections [3, 4]. Timely detection of recent HIV infection is crucial for two main reasons: (i) to provide behavioral interventions and antiviral therapy, thereby reducing the risk of secondary transmission; and (ii) to understand the characteristics of those recently infected, guiding targeted interventions based on behavioral and biological risks [5].

HIV recency assays utilize biomarkers to determine if an individual鈥檚 HIV-1 infection is recent (within one year of infection, with a confirmed negative test result from the previous year) or longstanding [6]. Traditionally, these assays have been used to estimate incidence rates [7]. However, recent efforts have focused on integrating recency assays into case surveillance systems and routine HIV testing services. This integration aims to measure additional indicators beyond incidence and to develop strategies for identifying hotspot populations and areas with high HIV transmission rates or emerging cases [6, 8, 9]. This approach enhances our understanding of HIV infection dynamics and supports effective control measures. Research on recent HIV infection is therefore vital for risk assessment, targeted interventions, and precision prevention and control, although further refinement is needed for non-incidence surveillance applications [9, 10].

Yunnan Province is located in the southwestern border region of China, bordering Myanmar, Laos and Vietnam, and is one of the provinces hardest hit by HIV-1 in China [11]. By the end of 2021, Yunnan Province had reported a cumulative total of 174,510 HIV/AIDS cases, with 124,372 people still alive [12]. Honghe Prefecture is located in the southeast of Yunnan, bordering Vietnam. Since 1995, when the first HIV-1 case was detected among the intravenous drug users (IDUs) in Honghe Prefecture, the number of HIV-1 infections in the region had increased [13]. A cross-sectional study of recent HIV-1 infections conducted in Yunnan Province in the past revealed a spatial clustering of recent infections in Honghe Prefecture and its neighboring Wenshan Prefecture, suggesting a higher incidence of new infections in the region [14]. However, studies focusing specifically on Honghe Prefecture have been limited primarily to examining HIV-1 prevalence rates without in-depth analysis of the characteristics and associated factors of recent infections within the prefecture. There is therefore a need to explore more comprehensive epidemic surveillance and to capture the epidemic characteristics and transmission risks of AIDS in a timely manner. Among these, recent HIV-1 infections are an important indicator for assessing AIDS trends [15]. In order to further identify high-risk populations and areas in the region, and to explore the risk of HIV-1 transmission, this study conducted a survey of newly infected persons among newly reported HIV-1 infections in Honghe Prefecture, combined with case detection characteristics, and timely detected hotspot populations and hotspot areas for HIV-1 transmission.

Methods

Study population

From January 2021 to December 2022, 2833 HIV-1-infected individuals were reported in Honghe Prefecture, of which 2698 were included in this study (95.2%). The inclusion criteria for subjects were: (1) age 15 years and above; (2) HIV-1 cases were reported between January 2021 and December 2022; (3) currently living in Honghe Prefecture; (4) willing to participate in the study and sign the informed consent. Participants with mental disorders, speech and hearing impairments, and other factors that may affect the completion of the survey were excluded. The Information about the subjects was collected through a questionnaire (Additional file 1). All subjects signed an informed consent form. This study was approved by the Biomedical Ethics Review Committee of the Yunnan Provincial Center for Disease Control and Prevention.

Identification of recently infected HIV-1 cases

To identify recent HIV-1 infections among newly diagnosed cases, an HIV-1 Limiting Antigen Avidity enzyme immunoassay (LAg-Avidity EIA, Maxim Biomedical, Inc., Rockville, USA) was used to classify recent infections from long-term infections. Recent infection testing algorithms (RITAs) were used to reduce the false recent rate (FRR) of the recency assays. Prior to performing the LAg-Avidity EIA, samples with CD4+ T cell counts < 200 cells/碌l and/or AIDS-defining illnesses were classified as long-term infections [16]. The LAg-Avidity ElA single-well preliminary screening test was first performed on all samples. Samples with a preliminary screening ODn value鈥�>鈥�2.0 were classified as long-term infection. If the ODn value is 鈮も��2.0, the samples need to be retested in a three-well assay to confirm the ODn value. In the confirmation testing, if the sample had an ODn value of 1.5 or less, the sample was classified as recent infection.

Spatial analysis

SaTScan v10.1.2 software was used for spatial scanning statistics to detect spatial clusters of HIV-1 infection cases and recent infection cases in Honghe Prefecture in 2021鈥�2022. To more accurately identify hot spots of HIV-1 transmission, a sensitivity analysis was conducted by setting the maximum spatial cluster size to 5%, 10%, 15%, 30% and 50% of the population at risk in the spatial window, respectively. When 50%, 30%, 15%, and 10% of the population at risk were used, the same number of spatial clusters were detected for the all-reported HIV-1 cases. For recent infections, the same number of spatial clusters were detected using 10% of the population at risk as using 30% and 15% of the population at risk. Therefore, 10% of the population at risk was chosen as the spatial size of the largest cluster. QGIS 3.28.8 was used to visualize all the data. The original map data was obtained from the National Catalogue Service for Geographic Information (; accessed on May 2, 2023). Population data from the official website of the Honghe Prefectural People鈥檚 Government (; accessed on January 12, 2023).

Statistical analysis

Statistical analysis was performed using SPSS 19.0. Logistic regression was used to calculate unadjusted odds ratios (OR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) for factors associated with recent HIV-1 infection. In the unadjusted analysis, the demographic and sexual characteristics, source of detection and other information were included. In the multifactor analysis, variables with a P鈥�<鈥�0.1 in the unadjusted analysis were considered to control for confounding factors. P鈥�<鈥�0.05 was considered statistically significant.

Results

Demographic characteristics of the study participants

Of the 2698 individuals eligible for inclusion, 68.2% (1840/2698) were male and 31.8% (858/2698) were female, with a male-to-female ratio of 2.14:1. The age ranged from 15 to 89 years, with those aged 鈮�50 years accounting for 41.1% (1108/2698). The main ethnic groups were Han (39.4%, 1063/2698), Hani (25.3%, 683/2698) and Yi (19.2%, 519/2698). Most were farmers (80.9%, 2184/2698), and 46.7% (1261/2698) were married and had a regular sexual partner. The educational level of most individuals was primary school education (46.0%, 1242/2698). More than half of the individuals (66.3%, 1790/2698) were detected through provider-initiated testing and Counselling (PITC). Heterosexual contact was the main mode of transmission (94.6%, 2551/2698) and most individuals had a history of non-marital and non-commercial heterosexual contact (53.0%, 1429/2698) (Table听1).

Table 1 Demographic characteristics of newly reported HIV-1 cases in Honghe Prefecture, 2021鈥�2022
Full size table

Characteristics of the recent infected cases

Of the 2689 eligible cases, 1073 were classified as long-term infection based on CD4+ T lymphocyte count and disease status at diagnosis, and 1625 (60.2%) underwent LAg avidity enzyme immunoassay. The proportion of recent HIV-1 infection was 297 (11.0%, 95% CI: 9.8-12.2%). (Fig.听1).

Fig. 1
figure 1

Flowchart of samples included in analyses and classified according to the recent infection testing algorithm, 2021鈥�2022

Full size image

Demographic characteristics of recent HIV-1 infection were analyzed by logistic regression (Table听2). Multivariable logistic regression analysis showed that the proportion of recent infections was higher among women (AOR鈥�=鈥�2.61, 95% CI: 1.98鈥�3.43), those aged 15鈥�34 years (AOR鈥�=鈥�1.71, 95% CI: 1.21鈥�2.43), those with a high school education or above (AOR鈥�=鈥�2.04, 95% CI: 1.24鈥�3.37), MSM (AOR鈥�=鈥�3.08, 95% CI: 1.74鈥�5.46) and those detected through spouse/sexual partner testing (AOR鈥�=鈥�1.96, 95% CI: 1.15鈥�3.33).

Table 2 Demographic factors associated with recent infection among newly reported HIV-1 infections in Honghe Prefecture, 2021鈥�2022
Full size table

Recent infections in the different subpopulations

Given that sex, age, route of transmission and mode of detection were associated with the proportion of recent infections, individuals were further divided into different subgroups for analysis.

First, the participants were grouped according to the transmission routes combined with sex and age (Table听3). Compared with heterosexually exposed men aged 15鈥�34 years, heterosexually exposed men aged 35鈥�49 years (OR鈥�=鈥�0.48, 95% CI: 0.30鈥�0.76) and 鈮モ��50 years (OR鈥�=鈥�0.63, 95% CI: 0.41鈥�0.99) had a lower proportion of recent infections, whereas heterosexually exposed women aged 15鈥�34 years (OR鈥�=鈥�1.85, 95% CI: 1.07鈥�3.19) and 35鈥�49 years (OR鈥�=鈥�1.65, 95% CI: 1.05鈥�2.58) and MSM aged 15鈥�34 years (OR鈥�=鈥�5.11, 95% CI: 2.73鈥�9.59) had a higher proportion of recent infections.

Table 3 Proportion of recent HIV infections in subgroups with different routes of infection
Full size table

Second, the participants were grouped according to the mode of exposure combined with sex (Table听4). Compared with men infected through non-marital non鈥揷ommercial heterosexual contact, MSM (OR鈥�=鈥�5.59, 95% CI: 3.30鈥�9.47), women infected through women infected through non-marital non-commercial heterosexual contact (OR鈥�=鈥�2.10, 95%CI: 1.50鈥�2.95) and positive spousal exposure (OR鈥�=鈥�3.03, 95% CI: 1.96鈥�4.69) had a higher proportion of recent infections.

Table 4 Proportion of recent HIV infections in subgroups with different routes of exposure
Full size table

Thirdly, the participants were grouped according to the screening approaches combined with sex (Table听5). The proportion of recent infections among women screened through PITC (OR鈥�=鈥�2.03, 95% CI: 1.50鈥�2.76) and spouse/fixed partner testing (OR鈥�=鈥�4.10, 95% CI: 2.19鈥�7.67) were higher.

Table 5 Proportion of recent HIV infections in subgroups with different sources of detection
Full size table

Spatial analysis for HIV-1 recent infections

The choropleth maps showed that the overall HIV-1 infections and recent HIV-1 infections were mainly distributed in the central and southeastern parts of Honghe Prefecture (Fig.听2). Spatial scan analysis revealed three clusters of newly reported HIV-1 cases (all P鈥�<鈥�0.001), with the primary cluster located in Yuanyang (RR鈥�=鈥�2.97) and the secondary cluster located in Kaiyuan (RR鈥�=鈥�1.50) and Gejiu (RR鈥�=鈥�1.25) (Fig.听2A). A primary cluster of recent infections was detected in Yuanyang (P鈥�&濒迟;鈥�0.001, RR鈥�=鈥�2.05) (Fig.听2B).

Fig. 2
figure 2

Spatial cluster of recent HIV infection cases in Honghe Prefecture, 2021鈥�2022. a The geographic distribution and spatial cluster of newly reported HIV-1 cases in Honghe Prefecture, 2021鈥�2022. b The geographic distribution and spatial cluster of recent infected cases in Honghe Prefecture, 2021鈥�2022. The map content approval number: YunS(2024)15

Full size image

Discussion

In this study, a survey of recent HIV-1 infection was conducted among newly diagnosed cases in Honghe Prefecture. Together with the demographic and spatial distribution characteristics, the potential factors associated with recent HIV-1 infection were further analyzed. Timely tracking of recent HIV-1 transmission is key to promoting early detection and effectively controlling the risk of transmission.

The proportion of recent infections among newly diagnosed HIV-1 cases in Honghe Prefecture in 2021鈥�2022 was 11.0%, which is higher than the that in the Yunnan Province in 2015 (9.3%, 蠂2鈥�=鈥�6.05, P鈥�=鈥�0.014) [14]. Since 2016, to promote the 90-90-90 targets, Yunnan Province has implemented HIV expanded testing strategies, and the testing coverage increased from 25.2 to 74.8% during 2015鈥�2020 [17]. As a key area for AIDS prevention and control in Yunnan Province, Honghe Prefecture has responded positively the HIV expanded testing strategies. In addition to routine VCT and PITC, the expanded HIV testing also included HIV mobilization testing in community and special settings and HIV screening integrated with medical examination, labor export programs and COVID-19 vaccination. These measures might have contributed to the early detection of infected persons, potentially increasing the proportion of recent infections. However, the proportion of recent infections remains relatively low, such as 14.2% in Ethiopia and 20.5% in Korea [18, 19]. Inadequate HIV detection and delayed diagnosis are major challenges facing the HIV response [15]. To increase the detection rate of new HIV infections, innovative testing models, such as the promotion of Internet鈥�+鈥塮acilitated testing and the implementation of HIV partner tracing and testing, are needed in addition to routine measures.

As found in the previous study, the proportion of recent HIV-1 infections was higher among women than among men [8, 20]. The analysis of subpopulations further revealed that the proportion of recent infections among heterosexually contact exposed women was higher than that among heterosexually contact exposed men in the different age groups. Due to physiological and sociological factors, women are at higher risk of HIV-1 infection than men [21, 22]. In 2022, approximately 210,000 young women (15鈥�24 years) worldwide were infected with HIV, which was much higher than the number of infected young men (15鈥�24 years) (140,000) [23]. The observed higher proportion of recent infections among women might be partially attributed to their better access to HIV testing services [24]. Women could be tested for HIV as part of basic public health services, such as women鈥檚 health care, maternity care, and so on. These measures could improve access to HIV testing for women and maximize the identification and management of female sources of HIV infection.

Our results also showed that the higher proportion of recent infections was among young people, especially in the 15鈥�34 age group. Among heterosexually and homosexually exposed men, the 15鈥�34 age group had the highest proportion of recent infections. Among heterosexually exposed women, the 15鈥�34 age group had a higher proportion of recent infections than the other age group. At the national level in China, the HIV epidemic is rising rapidly among young people aged 15鈥�24 [25]. Therefore, young people are one of the populations that need to be targeted for HIV/AIDS prevention and control. Further targeted interventions are needed for this subpopulation, including effectively improving their awareness of HIV/AIDS prevention. In addition, the overall proportion of recent infections, as well as the proportion of recent infections in different subpopulations, showed a decreasing trend with age increasing. This might be related to older adults鈥� lack of risk awareness and lower awareness of active detection after high-risk sexual behavior [26]. In this study, 71.3% (790/1108) of individuals aged鈥夆墺50 years were detected through PITC. As most older people had underlying health conditions, symptoms of HIV infection were often masked. The long interval between infection and case detection may result in missing opportunities for early testing.

Furthermore, our results suggested that recent HIV-1 infection was associated with educational status, the proportion of recent infections increased along with increasing educational status. As found, individuals with a high school education or higher were twice as likely to be found as recent infections than those who were no formal education (AOR鈥�=鈥�2.04, 95% CI: 1.24鈥�3.37). Based on the associated studies, we speculated that the lower proportion of recent infections among individuals with low education may be related to their lack of awareness of HIV testing, while the high proportion of recent infections among individuals highly educated may be related to their greater awareness of HIV testing and high level of knowledge about HIV/AIDS prevention and control [27, 28]. These differences indicate a need to consider strengthening AIDS promotion and education tailored to people with different levels of education. For people with low levels of education, the priority should be to reduce high-risk behaviors and increase the awareness of active HIV testing; for people with high levels of education, the priority should be to improve the effectiveness and accessibility of intervention services.

In this study, the proportion of recent infections in MSM (32.1%) was much higher than in heterosexual transmission (10.5%). The previous studies showed that MSM had a higher rate of unprotected sex, multiple sexual partners and recreational drug use [29,30,31]. Meanwhile, the rate of condom use during sexual intercourse among MSM was less than 60% [32, 33]. The relevant studies also showed that the HIV incidence among MSM was higher than heterosexual transmission [34, 35]. However, more than 50% of MSM had regular HIV testing [31, 36]. MSM constitute a particular group and may hesitate to reveal their identity given the cultural context of China. Interventions for this group mainly rely on community-based organizations (CBOs) and are carried out through peer-driven approaches, including regular follow-up testing for MSM participating in intervention programs [37]. Furthermore, new methods utilizing mobile phones and internet platforms have been introduced, which can help to some extent in the early identification and referral of infected individuals for treatment [38]. To reduce new infections among MSM, the coverage and effectiveness of MSM interventions through CBOs should be increased, including improving awareness of condom use and promoting pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) services.

Although there was no statistical difference, the proportion of recent infections among IDUs was lower than that among the heterosexual population. Effective interventions, such as needle exchange and methadone substitution therapy, were implemented for IDUs, which may have contributed to a decrease in HIV-1 infections among this group [39]. In recent years, the proportion of IDUs among newly reported cases in Yunnan Province has remained low [40]. Nevertheless, due to the illegal nature of injecting drug use, some IDUs may be reluctant to access intervention services and may not be easily reached by testing services.

PITC relies on the established medical service system to provide HIV testing services under the condition of informed consent. PITC is currently the primary means of identifying infected individuals, and this has been recognized in Yunnan Province鈥檚 prevention and control strategies. Consistent with the overall situation in Yunnan Province, PITC was the predominant route for HIV case detection in Honghe Prefecture. In our studies, the proportion of recent infections among cases detected through PITC was 10.7%, which was close to the average proportion of recent infections (11.0%). Unlike PITC, VCT is a way to actively seek HIV testing after high-risk behavior. In theory, VCT should have a higher rate of detection of recent infections. In this study, the proportion of recent infections detected by VCT (13.8%) was slightly higher than PITC, but there was no statistically significant difference between the two groups. This suggested, to some extent, that the general population had low awareness of actively seeking HIV testing after engaging in high-risk behaviors or was unaware of available HIV testing services. From an individual health perspective, the knowledge of HIV testing and awareness of proactive testing should be further strengthened. From a service delivery perspective, the advantage and effectiveness of VCTs should be strengthened to avoid homogenization of VCTs and PITCs.

The highest proportion of recent infections (19.4%) was found among individuals detected through spouse/sexual partner testing, suggesting that spouses or sexual partners of HIV-1-positive individuals were vulnerable. In particular, the proportion of recent infections among women detected in this way (27.3%) was higher than that among men (11.3%), suggesting that the female partner was more likely to be infected in HIV serodiscordant couples. Therefore, to reduce the risk of HIV transmission and prevent positive conversion among HIV serodiscordant couples, it is necessary to increase spouse/partner notification, implement condom distribution and use, and standardize antiviral treatment for the positive side.

In the implementation of the expanded HIV testing strategy, measures for HIV testing were widely explored and practiced, such as community mobilization testing, testing for migrant workers, testing combined with basic public health services and so on. The proportion of recent infections detected by these detection methods (9.0%) was slightly lower than by PITC, but the difference was not statistically significant. These detection methods expanded the coverage of detection in practice. To effectively increase the discovery rate, it is necessary to further explore the relevance of detection, refine detection plans, and create an appropriate policy support environment.

Spatial clusters and 鈥渉otspots鈥� of disease indicate an increased risk of disease. Hotspots can provide clues to disease etiology and risk factors [41]. Using spatial scan statistics, we simultaneously detected significant clusters of HIV-1 infection cases and recent HIV-1 infections in Yuanyang, indicating that Yuanyang had a high risk of HIV-1 transmission. In Kaiyuan and Gejiu, we found a cluster of HIV-1 infection cases, but no cluster of recent HIV-1 infections. This suggested that there could be some delay in diagnosing people infected with HIV-1 in these areas. More attention should be paid to these areas to avoid increasing the risk of epidemic spread due to delayed diagnosis in the future. Spatial analysis of recent HIV-1 infections can reveal the epidemic trend of the current epidemic and identify potential transmission hotspots. For policy makers and planners, this information can guide the formulation of effective public health intervention strategies in hotspot areas, inform epidemic prevention and control, and provide data to support resource configuration.

There are also limitations to this study. First, the cross-sectional design precludes causal inferences between demographic factors and recent infections. Second, despite the use of a recent infection algorithm, it cannot be completely excluded that a small number of long-term infections were misclassified as recent infections due to the limitations of the detection method. Third, due to the short time span of the study, it is not possible to reflect the trend of recent infections.

Conclusion

In this study, based on HIV case-report surveillance, a survey of recent HIV-1 infection was conducted in one of the most HIV-1-affected areas in Yunnan Province, China. The overall proportion of recent infections was relatively low in the local area, suggesting that HIV diagnosis is still delayed. More proactive interventions are needed to improve early diagnosis and hence early initiation of ART. The demographic and behavioral characteristics, such as sex, age, education, exposure mode, were associated with the detection of recent infection. Further analysis revealed the different key subpopulations. Spatial analysis of recent HIV-1 infections showed that there were differences in the distribution of recent HIV-1 infections, with a cluster of recent infections detected in Yuanyang. This study informed the use of recency testing for surveillance. The results provided a scientific reference to guide the adjustment of AIDS prevention and control strategies.

Data availability

This paper is based on public health surveillance data collected continuously by the Honghe Centers for Disease Control and Prevention in Honghe Prefecture. The study database used and/or analysed in the current study is available from the corresponding author upon reasonable request.

Abbreviations

AHI:

Acute HIV infection

AIDS:

Acquired immune deficiency syndrome

AOR:

Adjusted odds ratio

ART:

Antiretroviral therapy

CI:

Confidence interval

EHI:

Early HIV infection

FRR:

False recent rate

IDUs:

Injecting drug users

LLR:

Log-likelihood ratio

LT:

Long-term infection

MSM:

Men having sex with men

OR:

Odds ratio

PEP:

Post-exposure prophylaxis

PITC:

Provider-initiated testing and counseling

PrEP:

Pre-exposure prophylaxis

RHI:

Recent HIV infection

RITA:

Recent infection testing algorithm

RR:

Relative risk

STD:

Sexually transmitted disease

VCT:

Voluntary counseling and testing

WHO:

World health organization

References

  1. UNAIDS, Global HIV. & AIDS statistics - Fact sheet 2023. Available from: . Accessed 20 Oct 2023.

  2. World Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022鈥�2030. Available from: . Accessed 20 Oct 2023.

  3. Brenner BG, Roger M, Routy JP, Moisi D, Ntemgwa M, Matte C, Baril JG, Thomas R, Rouleau D, Bruneau J et al. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis 2007;195(7).

  4. Vasylyeva TI, Friedman SR, Smyrnov P, Bondarenko K. A new approach to prevent HIV transmission: Project protect intervention for recently infected individuals. AIDS Care. 2015;27(2):223鈥�8.

    CAS听 听 听

  5. Nikolopoulos GK, Tsantes AG. Recent HIV infection: diagnosis and Public Health implications. Diagnostics (Basel Switzerland). 2022;12(11):2657.

    CAS听 听 听

  6. World Health Organization. Using recency assays for HIV surveillance 2022 technical guidance. Available from: . Accessed 22 Oct 2023.

  7. Duong YT, Dobbs T, Mavengere Y, Manjengwa J, Rottinghaus E, Saito S, Bock N, Philip N, Justman J, Bicego G, et al. Field Validation of limiting-Antigen avidity enzyme Immunoassay to Estimate HIV-1 incidence in cross-sectional survey in Swaziland. AIDS Res Hum Retroviruses. 2019;35(10):896鈥�905.

    CAS听 听 听

  8. Yang H, Li Y, He F, Yuan F, Liu L, Li L, Yuan D, Ye L, Zhou C, Zhang Y, et al. Demographic characteristics and hot-spot areas of recent infections among New HIV diagnoses in Sichuan, China, between 2018 and 2020. Infect Drug Resist. 2023;16:779鈥�89.

    听 听 听

  9. Kin-On Lau J, Murdock N, Murray J, Justman J, Parkin N, Miller V. A systematic review of limiting antigen avidity enzyme immunoassay for detection of recent HIV-1 infection to expand supported applications. J Virus Eradication. 2022;8(3):100085.

    CAS听 听

  10. Facente SN, Grebe E, Maher AD, Fox D, Scheer S, Mahy M, Dalal S, Lowrance D, Marsh K. Use of HIV recency assays for HIV Incidence Estimation and other Surveillance Use cases: systematic review. JMIR Public Health Surveillance. 2022;8(3):e34410.

    听 听 听

  11. Wang JJ, Zhu ZB, Yang X, Wu J, Wang HB, Feng L, Ding GW, Norris JL, Wang N. Herpes simplex virus type 2 risks in female sex workers in the China-Vietnam border county of Hekou. Biomed Environ Sci: BES. 2012;25(6):706鈥�10.

    听 听

  12. Fu LR, Xiao MY, Jia MH, Song LJ, Li XH, Niu J, Wang XW, Zhang ZY, Ma YL, Luo HB. Analysis on survival time and influencing factors among reported HIV/AIDS in Yunnan Province, 1989鈥�2021. Chin J Epidemiol. 2023;44(6):960鈥�5.

    CAS听 听

  13. Duang Q, Zhang W, Chang L, Yao E, Shao Y, Wang J. Operation and effectiveness of the Network for Follow-Up Management of HIV/AIDS patients in Honghe Prefecture. 2014,20:617鈥�20.

  14. Chen M, Ma Y, Chen H, Dai J, Luo H, Yang C, Dong L, Jin X, Yang M, Yang L, et al. Demographic characteristics and spatial clusters of recent HIV-1 infections among newly diagnosed HIV-1 cases in Yunnan, China, 2015. 樱花视频. 2019;19(1):1507.

    听 听 听

  15. Tang H, Li D, Qin Q, Chen F, Ge L, Cai C, Lv F. Inheritance and development evidence based, promoting the quality of AIDS surveillance in China. Chin J AIDS STD. 2023;29(07):733鈥�6.

    听

  16. World Health Organization. When and How to Use Assays for Recent Infection to Estimate HIV Incidence at a Population Level. 2011 [Accessed 22 June 2020].

  17. Ma Y, Lou J, Lao Y, Jia M. Strategy and effectiveness on achieving the 90-90-90 targets of AIDS prevention and treatment in Yunnan Province. Chin J AIDS STD. 2022;28(8):884鈥�7.

    听

  18. Yoo M, Wang J-S, Park S-J, Cha J-O, Jung Y, Chung Y-S, Han MG, Choi B-S, Kim S-S, Kee M-K. Characteristics of recent HIV infection among individuals newly diagnosed as HIV-positive in South Korea (2008鈥�2015). Sci Rep. 2022;12(1):10515.

    CAS听 听 听 听

  19. Alemu T, Ayalew M, Haile M, Amsalu A, Ayal A, Wale F, Belay A, Desta B, Taddege T, Lankir D, et al. Recent HIV infection among newly diagnosed cases and associated factors in the Amhara regional state, Northern Ethiopia: HIV case surveillance data analysis (2019鈥�2021). Front Public Health. 2022;10:922385.

    听 听 听

  20. Telford CT, Tessema Z, Msukwa M, Arons MM, Theu J, Bangara FF, Ernst A, Welty S, O鈥橫alley G, Dobbs T, et al. Geospatial transmission hotspots of recent HIV infection - Malawi, October 2019-March 2020. MMWR Morbidity Mortal Wkly Rep. 2022;71(9):329鈥�34.

    听

  21. Nelson E-UE. Structural inequities, HIV vulnerability and women鈥檚 agency: Street-based sex workers in Nigeria. Glob Public Health. 2020;15(12):1800鈥�9.

    听 听

  22. Adland E, Millar J, Bengu N, Muenchhoff M, Fillis R, Sprenger K, Ntlantsana V, Roider J, Vieira V, Govender K, et al. Author correction: sex-specific innate immune selection of HIV-1 in utero is associated with increased female susceptibility to infection. Nat Commun. 2020;11(1):2257.

    CAS听 听 听 听

  23. UNAIDS. Executive summary - The path that ends AIDS: UNAIDS Global AIDS Update 2023. Available from: . Accessed 10 Nov 2023.

  24. Msukwa MT, MacLachlan EW, Gugsa ST, Theu J, Namakhoma I, Bangara F, Blair CL, Payne D, Curran KG, Arons M, et al. Characterising persons diagnosed with HIV as either recent or long-term using a cross-sectional analysis of recent infection surveillance data collected in Malawi from September 2019 to March 2020. BMJ Open. 2022;12(9):e064707.

    听 听 听

  25. Han M. Analysis and prospects of the AIDS prevalence, prevention and treatment in China. Chin J AIDS STD. 2023;29(03):247鈥�50.

    听

  26. Guo Y, Sims OT. Assessment of recent HIV testing among older adults in the United States. Soc Work Health Care. 2017;56(9):855鈥�64.

    听 听

  27. Johansson K, Persson KI, Deogan C, El-Khatib Z. Factors associated with condom use and HIV testing among young men who have sex with men: a cross-sectional survey in a random online sample in Sweden. Sex Transm Infect. 2018;94(6):427鈥�33.

    听 听

  28. Jiao K, Wei R, Li H, Chow EPF, Piqueiras E, Lewis T, Xu Z, Ren C, Ma W. HIV testing frequency and associated factors among five key populations in ten cities of China: a cross-sectional study. 樱花视频 Infect Dis. 2022;22(1):195.

    听 听 听

  29. Chen J, Huang YL, Chen HL, Xia J. Nitrite inhalants use, sexual behaviors and HIV/syphilis infection among men who have sex with men in Chongqing, China. Infect Dis Poverty. 2020;9(1):127.

    听 听 听

  30. Goldshear JL, Westmoreland DA, Carrico AW, Grov C. Drug use typology, demographic covariates, and associations with condomless anal sex: a latent class analysis among a U.S. national cohort of men who have sex with men. Int J Drug Policy. 2023;112:103949.

    听 听

  31. Wang X, Zhang T, Chang Q, Wang C, Wang K, Yu Z, Zhang H, Huang H, Song D, Peixoto E, et al. The risk of acute and early HIV (AEH) infection among MSM with different behaviour trajectories: an open cohort study in Tianjin, China, 2011鈥�2019. 樱花视频 Infect Dis. 2023;23(1):37.

    CAS听 听 听 听

  32. Dou Z, Zhang Z, Rui B. Research progress on HIV prevalence and risk behaviors among adolescent MSM in China. Chin J School Health. 2020;41(12):1915鈥�20.

    听

  33. Lew C, Fairley CK, Tran J, Phillips TR, Maddaford K, Chen MY, Bradshaw CS, Chow EPF. High-Risk Sexual Activities and Condom Use Patterns During Group Sex Among Men Who Have Sex With Men in Melbourne, Australia. Journal of Acquired Immune Deficiency Syndromes (1999) 2023;93(5):356鈥�363.

  34. Slurink IAL, van de Baan F, van Sighem AI, van Dam AP, van de Laar TJW, de Bree GJ, van Benthem BHB. Op de Coul ELM: monitoring recently acquired HIV infections in Amsterdam, the Netherlands: the attribution of test locations. Front Reproductive Health. 2021;3:568611.

    听

  35. Ang LW, Low C, Wong CS, Boudville IC, Toh MPHS, Archuleta S, Lee VJM, Leo YS, Chow A, Lin RT-P. Epidemiological factors associated with recent HIV infection among newly-diagnosed cases in Singapore, 2013鈥�2017. 樱花视频. 2021;21(1):430.

    CAS听 听 听 听

  36. Jiang H, He W, Pan H, Zhong X. A structural equation modeling approach to investigate HIV testing willingness for men who have sex with men in China. AIDS Res Therapy. 2023;20(1):64.

    听

  37. Leng Z, Sha S, Dai S, Meng X, Li J, Jin J, Zheng W, Yang W, Mao C, Wang Z, et al. Role of social organization engagement in high-risk groups intervention against HIV/AIDS: a case study from 176 cities of China. Infect Dis Poverty. 2022;11(1):126.

    听 听 听

  38. Fan RQ, Shu JT, Huang H, Shi LY, Ge QW, Zhuang X, Zou MY, Qin G. Economic evaluation of short message service intervention for HIV prevention among men who have sex with men in China: a modelling study. 樱花视频. 2024;24(1):3553.

    听 听 听

  39. Yang L, Chen M, Ma Y, Luo H, Yang C, Su Y, Chen H, Shi Y, Mei J, Jia M, et al. The changing trends of HIV-1 prevalence and incidence from sentinel surveillance of five sub-populations in Yunnan, China, 2001鈥�2010. 樱花视频. 2015;15(1):376.

    听 听 听

  40. 2023 Yunnan Provincial Health Commission, Province HIV/ AIDS, Epidemic and Prevention Work Press Conference. 2023 Dec 4 [cited 2025 Jan 11]. Available from:

  41. McLafferty S. Disease Cluster detection methods: recent developments and public health implications. Ann GIS. 2015;21(2):127鈥�33.

    听

Acknowledgements

We thank the staff at the Honghe Centers for Disease Control and Prevention for their assistance in sample collection.

Funding

This work was supported by the National Natural Science Foundation of China (82160635), the Yunnan Health Training Project of High Level Talents (L-2024020) and the Yunnan Revitalization Talents Support Program (Special Project for Famous Doctors). The funders had no role in the study design, data collection and analysis, interpretation of the data, or preparation of the manuscript.

Author information

Author notes

  1. Xiao Zhang, Lijuan Dong and Tao Zhou contributed equally to this work.

Authors and Affiliations

  1. Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, China

    Xiao Zhang

  2. Yunnan Provincial Key Laboratory of Public Health and Biosafety & Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China

    Lijuan Dong,听Huichao Chen,听Yu Han,听Xiaomei Jin,听Jie Dai,听Min Yang,听Zhijun Zeng,听Pengyan Sun,听Yanling Ma,听Yuhua Shi听&听Manhong Jia

  3. Division for AIDS/STD Control and Prevention, Honghe Center for Disease Control and Prevention, Honghe, Yunnan, China

    Tao Zhou

  4. Yunnan Provincial Key Laboratory of Public Health and Biosafety & Health Laboratory Center, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China

    Min Chen

Authors
  1. Xiao Zhang

    You can also search for this author in听

  2. Lijuan Dong

    You can also search for this author in听

  3. Tao Zhou

    You can also search for this author in听

  4. Huichao Chen

    You can also search for this author in听

  5. Yu Han

    You can also search for this author in听

  6. Xiaomei Jin

    You can also search for this author in听

  7. Jie Dai

    You can also search for this author in听

  8. Min Yang

    You can also search for this author in听

  9. Zhijun Zeng

    You can also search for this author in听

  10. Pengyan Sun

    You can also search for this author in听

  11. Yanling Ma

    You can also search for this author in听

  12. Yuhua Shi

    You can also search for this author in听

  13. Min Chen

    You can also search for this author in听

  14. Manhong Jia

    You can also search for this author in听

Contributions

M.J., M.C., and Y.S. conceptualized the study. M.J. and M.C. acquired funding. T.Z., X.Z., and L.D. collected the samples. Y.S. and Y.H. gathered epidemiological data. X.Z., L.D., H.C., X.J., J.D., M.Y., Z.Z., and P.S. performed the experiments. X.Z., M.C., and Y.M. analyzed the data. X.Z., M.C., and M.J. wrote the original draft of the manuscript. X.Z., L.D., Z.Z., H.C., Y.H., X.J., J.D., M.Y., Z.Z., P.S., Y.M., Y.S., M.C., and M.J. revised and finally approved the manuscript.

Corresponding authors

Correspondence to Yuhua Shi, Min Chen or Manhong Jia.

Ethics declarations

Ethics approval and consent to participate

This study was in accordance with the Declaration of Helsinki, and was approved by the Biomedical Ethics Review Committee of the Yunnan Centre for Disease Control and Prevention. All research subjects recruited for this study were fully informed about the nature and purpose of the research, and they each signed the informed consent form. Consent for adult participants was provided by themselves, while consent for juvenile participants (aged 15鈥�17 years) was provided by their legal guardians.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher鈥檚 note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

: Additional file 1: Risk factor questionnaire for newly reported HIV/AIDS cases.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article鈥檚 Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article鈥檚 Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit .

About this article

Cite this article

Zhang, X., Dong, L., Zhou, T. et al. Analysis of HIV-1 recent infections and hotspot areas in a bordering area in Yunnan Province, China. 樱花视频 25, 1122 (2025). https://doi.org/10.1186/s12889-025-21877-3

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-025-21877-3

Keywords

樱花视频

ISSN: 1471-2458

Contact us