HIV upsurge in China's students

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Science  24 May 2019:
Vol. 364, Issue 6442, pp. 711
DOI: 10.1126/science.aay0799

Thirty years ago, China experienced its first indigenous HIV/AIDS cases. Since then, HIV has spread from drug users and blood transfusion recipients to the general urban population, mainly through sexual routes. Particularly worrisome is the recent increase of HIV infection among college students, according to the Chinese Center for Disease Control and Prevention (CDC). The number of newly diagnosed college students has seen an annual growth rate ranging from 30 to 50% over the past several years. A proactive approach is required to spread public awareness of this trend and to promote aggressive prevention and treatment measures.

One factor that underlies this growing epidemic is likely the limited precollege sex education. Because only one-third of China's highest academically ranked youth attend college, pre-college education is focused on scholarly studies. Recent surveys indicate that about half of college students received sex education, which is usually minimal [does not include precautions on HIV and sexually transmitted diseases (STDs)], conservative, and heteronormative (which perpetuates a stigma associated with homosexuality and HIV infection).

Vending machines offer HIV test kits at a Chinese university.


There is also a more open attitude toward casual sex in China. Around 60 to 80% of college students are accepting of premarital sex and having multiple sex partners. Coupled with the lack of sex education, there is an increased risk of spreading HIV and STDs. The associated cultural stigma also encourages HIV-positive and STD-positive individuals to conceal their status, creating invisible disease transmitters in the population. Another factor is social media, which can increase exposure to sexual content and facilitate convenient access to various potential partners. About 50% of Chinese users of the largest gay social network app in China (Blued) are aged 18 to 25.

Although the Chinese government announced a 2015 policy to increase HIV health care services in colleges, its current implementation is ineffective. The obstacles have included insufficient attention by the education sector, failure to implement health care budgets, lack of publicizing HIV, and students' lack of self-motivation for prevention and treatment.

What is the way forward, then? Education and health care sectors need to work together to tailor policies for HIV prevention and care for students on campus. College administrators must foster an open environment for education and awareness on HIV/AIDS and also provide counseling and testing while protecting student privacy. Student organizations can work with public health professionals to disseminate basic information about HIV/AIDS in more engaging ways. For example, the Red Cross at Tsinghua University designed an innovative and popular game where students solve HIV/AIDS–related puzzles while learning about the disease. Education campaigns should take advantage of the internet, mobile phones, and social media frequently accessed by students. And colleges also could provide a readily accessible means of testing for infections. In 2018, China's CDC made anonymous HIV urine-testing services available through vending machines in over 40 universities. This not only provides access to HIV/AIDS testing, but also improves awareness and enhances students' motivation for HIV protection. This pilot approach certainly could be scaled up to a national level.

China's policy-makers should also consider aggressive responses that have been successful elsewhere. For example, in the United States, there are programs at STD clinics through which pre-exposure prophylaxis is provided to those with higher risks of infection or to those who have requested HIV testing. It is anticipated that the antiretroviral medication Truvada for HIV prevention will be available in the next year or two. College students should have access to these drugs. Innovations in male circumcision that have made the procedure safer, quicker, and cost-effective should also be accessible to college students.

China can take many actions to address the uptick in HIV/AIDS among college students. The challenge is for China to show a much stronger—and faster—will to act.

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