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The human immunodeficiency virus (HIV) epidemic in China remains interspersed nationwide but is highly concentrated in some regions and in some high-risk populations (1). The rate of newly diagnosed cases of HIV have rapidly increased, and HIV is still been a major public health challenge in China (2). From 2012 to 2019, a total of 942,705 cases of HIV in individuals aged 15 years or above were newly diagnosed and recorded in the Chinese HIV/AIDS Comprehensive Response Information Management System (CRIMS), and the number of newly diagnosed HIV infections increased year over year. Of them, 42,242 HIV cases were infected via injection drug use (IDU) and the annual number of newly diagnosed HIV infections via IDU decreased. The variables in the analysis of the CRIMS database included demographic characteristics (gender, date of birth, current address code, nationality, marital status, education level, occupation, etc.), infection route, source of sample, date of diagnosis, date of verification, and baseline CD4 T+ lymphocytes (CD4) cell counts. Age was calculated by the difference between the date of diagnosis and the date of birth. CD4 cell count was a major indicator of HIV infection disease progression. Baseline CD4 cell counts were greater than or equal to 500 cells/mm3, which meant that the HIV infection time was less than two years (less than two years (3) and was designated as the standard of new infection. Data processing and analyses were conducted using SAS software (version 9.4; SAS Institute; Cary, NC).
From January 1, 2012 to December 31, 2019, there were 42,242 newly diagnosed cases of HIV in individuals aged 15 years and above who were infected via IDU, accounting for 4.5% of the total newly diagnosed cases of HIV in this period, and the proportion showed decreases year over year (χ2=12780.98,p<0.001) (Table 1).
Year of
diagnosisNewly diagnosed
case of HIV*Newly diagnosed
cases HIV
infected via IDU*Proportion
(%)2012 81,567 8,242 10.1 2013 89,236 6,952 7.8 2014 102,649 6,213 6.1 2015 114,656 5,010 4.4 2016 123,809 4,987 4.0 2017 133,713 4,585 3.4 2018 146,772 4,423 3.0 2019 150,303 1,830 1.2 Total 942,705 42,242 4.5 * Individuals aged 15 years and over. Table 1.Number and proportion of newly diagnosed cases of HIV infected via injection drug use (IDU) — China, 2012–2019.
Of the 42,242 newly diagnosed cases of HIV infected via IDU during 2012–2019, 85.5% of individuals were males, 61.1% had at most a primary school education or were illiterate, 40.6% were married and living with partners, 60.3% were of non-Han ethnicities, 50.2% were farmers, and 46.3% were diagnosed from detention centers. The major age group was 25–44 years old, accounting for 76% of newly diagnosed cases of HIV infected via IDU (Table 2). For educational levels based on age groups, 67.8% and 68.5% of individuals aged 15–24 years and 25–34 years had education levels below primary school, respectively.
Characteristics 2012 2013 2014 2015 2016 2017 2018 2019 Total Gender Male 7,101(86.2) 5,976(86.0) 5,350(86.1) 4,245(84.7) 4,253(85.3) 3,813(83.2) 3,818(86.3) 1,545(84.4) 36,101(85.5) Female 1,141(13.8) 976(14.0) 863(13.9) 765(15.3) 734(14.7) 772(16.8) 605(13.7) 285(15.6) 6,141(14.5) Age group (years) 15–24 978(11.9) 856(12.3) 687(11.1) 495(9.9) 437(8.8) 399(8.7) 361(8.2) 107(5.8) 4,320(10.2) 25–34 3,429(41.6) 2,888(41.5) 2,596(41.8) 2,019(40.3) 2,040(40.9) 1,736(37.9) 1,619(36.6) 566(30.9) 16,893(40.0) 35–44 3,089(37.5) 2,520(36.2) 2,242(36.1) 1,803(36.0) 1,738(34.9) 1,599(34.9) 1,591(36.0) 636(34.8) 15,218(36.0) 45–54 647(7.9) 602(8.7) 601(9.7) 618(12.3) 700(14.0) 751(16.4) 720(16.3) 415(22.7) 5,054(12.0) 55– 99(1.2) 86(1.2) 87(1.4) 75(1.5) 72(1.4) 100(2.2) 132(3.0) 106(5.8) 757(1.8) Marital status Married, or living with partner 3,192(38.7) 2,578(37.1) 2,338(37.6) 1,904(38.0) 2,106(42.2) 2,179(47.5) 2,184(49.4) 660(36.1) 17,141(40.6) Single 3,340(40.5) 2,859(41.1) 2,497(40.2) 1,930(38.5) 1,815(36.4) 1,420(31.0) 1,306(29.5) 685(37.4) 15,852(37.5) Divorced, or widowed 1,390(16.9) 1,323(19.0) 1,178(19.0) 1,070(21.4) 941(18.9) 901(19.7) 792(17.9) 471(25.7) 8,066(19.1) Unknown 320(3.9) 192(2.8) 200(3.2) 106(2.1) 125(2.5) 85(1.9) 141(3.2) 14(0.8) 1,183(2.8) Education College and above 84(1.0) 60(0.9) 68(1.1) 86(1.7) 74(1.5) 80(1.7) 89(2.0) 83(4.5) 624(1.5) High school or technical secondary school 516(6.3) 433(6.2) 431(6.9) 294(5.9) 293(5.9) 285(6.2) 234(5.3) 155(8.5) 2,641(6.3) Junior high school 2,968(36.0) 2,330(33.5) 1,892(30.5) 1,668(33.3) 1,462(29.3) 1,223(26.7) 998(22.6) 641(35.0) 13,182(31.2) Primary school 2,983(36.2) 2,472(35.6) 2,349(37.8) 1,684(33.6) 1,705(34.2) 1,462(31.9) 1,545(34.9) 579(31.6) 14,779(35.0) Illiterate 1,691(20.5) 1,657(23.8) 1,473(23.7) 1,278(25.5) 1,453(29.1) 1,535(33.5) 1,557(35.2) 372(20.3) 11,016(26.1) Ethnicity Han 3,623(44.0) 2,758(39.7) 2,451(39.4) 2,128(42.5) 1,942(38.9) 1,619(35.3) 1,373(31.0) 885(48.4) 16,779(39.7) Other 4,619(56.0) 4,194(60.3) 3,762(60.6) 2,882(57.5) 3,045(61.1) 2,966(64.7) 3,050(69.0) 945(51.6) 25,463(60.3) Occupation Farmer or rural laborer 3,570(43.3) 3,530(50.8) 2,954(47.5) 2,413(48.2) 2,567(51.5) 2,500(54.5) 2,763(62.5) 907(49.6) 21,204(50.2) Housekeeping service or unemployment 2,596(31.5) 2,156(31.0) 2,138(34.4) 1,597(31.9) 1,468(29.4) 1,207(26.3) 989(22.4) 562(30.7) 12,713(30.1) Other 1,648(20.0) 772(11.1) 749(12.1) 692(13.8) 659(13.2) 734(16.0) 565(12.8) 315(17.2) 6,134(14.5) Unknown 428(5.2) 494(7.1) 372(6.0) 308(6.1) 293(5.9) 144(3.1) 106(2.4) 46(2.5) 2,191(5.2) Site of diagnosis Voluntary counseling and testing centers 1,414(17.2) 1,175(16.9) 879(14.1) 647(12.9) 794(15.9) 641(14.0) 318(7.2) 226(12.3) 6,094(14.4) Hospital 2,187(26.5) 1,935(27.8) 1,749(28.2) 1,399(27.9) 1,451(29.1) 1,316(28.7) 720(16.3) 516(28.2) 11,273(26.7) Detention center 3,853(46.7) 3,271(47.1) 2,990(48.1) 2,408(48.1) 2,438(48.9) 2,081(45.4) 1,661(37.6) 850(46.4) 19,552(46.3) Other 637(7.7) 421(6.1) 531(8.5) 503(10.0) 271(5.4) 517(11.3) 1,680(38.0) 228(12.5) 4,788(11.3) Table 2.Demographic characteristics of newly diagnosed cases of HIV infected via injection drug use ─ China, 2012–2019.
Of the newly diagnosed cases of HIV infected through IDU in 2012–2019, 28.0% of individuals had baseline CD4 cell counts greater than or equal to 500 cells/mm3, but this figure decreased year over year from 2012 to 2019 (χ2=186.60,p<0.001) (Figure 1). During the same period, 17.8% of the newly diagnosed cases of HIV infected not through IDU had baseline CD4 cell counts greater than or equal to 500 cells/mm3.
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In the past 30 years, the main mode of transmission of HIV in China has changed drastically as the primary route of transmission has changed from IDU to sexual transmission. The prevention and control of the HIV epidemic in drug users has achieved great successes as the annual incidence of HIV among drug users participating in methadone maintenance treatment (MMT) has reached zero and HIV prevalence of among drug users has decreased year over year, which suggests that the control of the HIV epidemic among drug users has been largely successful (4). During the study period of 2012–2019, only 4.5% of newly diagnosed cases of HIV were infected via IDU, and this proportion dropped from 10.1% in 2012 to 1.2% in 2019. During this same period, the results of sentinel surveillance of drug users in China also showed decreases in the HIV antibody positive rate (5). In 2012, the HIV antibody positive rate in the sentinel surveillance of drug users was 3.9% (6), and it was 2.4% in 2019 (7).
The main demographic characteristics of newly diagnosed cases of HIV infected via IDU indicated that most individuals were males, had low levels of education, were of non-Han ethnicity, and were farmers. The results indicating that the educational level of not completing primary school in individuals aged 15–24 years (67.8%) and 25–34 years (68.5%) indicated that HIV prevention efforts for these populations were likely difficult and that traditional methods to disseminate health knowledge or provide health information may prove suboptimal for these populations.
During 2012–2019, the annual number of newly diagnosed cases of HIV infected via IDU was decreasing year over year, but 28.0% of individuals had baseline CD4 cell counts greater than or equal to 500 cells/mm3, which indicated that these individuals may have been infected within the past two years and that HIV transmission via IDU has not been completely eliminated and that the risk of transmission still exists. MMT has played an important role in reducing the incidence of HIV among injection drug users (8), and the incidence of HIV among outpatients of MMT clinics in China decreased from 0.2/100 person-years in 2012 to 0.02/100 person-years in 2019. However, newly diagnosed cases of HIV infected via IDU with the first CD4 cell counts exceeding 500 cells/mm3were mainly from the detention centers, which indicated that these individuals were possibly arrested and diagnosed in the detention centers due to drug abuse.
This study was subject to some limitations. First, the analysis was based on newly diagnosed cases of HIV infected via IDU and was likely influenced by the scope of HIV testing and by recording methodology. Second, determining the true sources of infection for the cases was unlikely to be definitive. Further case tracing and molecular transmission network analysis can help determine these sources of infection with greater certainty and better inform targeted interventions to reduce the risk of HIV transmission via IDU.
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Conflict of Interests:The authors declare no competing interests.
Figure 1.Proportion of baseline CD4 cell counts in newly diagnosed cases of HIV infected via injection drug use (IDU) — China, 2012–2019.
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