Abstract
Despite the implementation of health education and free condom distribution for decades, the HIV/AIDS epidemic among older adults in China shows no sign of declining. This study aims to identify HIV transmission patterns and pathways in a rural county area and provide insight for developing effective HIV prevention strategies among older adults. Epidemiological field surveys combined with phylogenetic analysis were used to identify potential HIV transmission linkage in one rural county with a rapidly increasing HIV epidemic among older adults. A total of 160 HIV-positive individuals and their HIV-positive sexual partners diagnosed between 2015 and 2018 were recruited. Among them, 69.4% (n = 111) were diagnosed at age 50 or older, 68.1% (n = 109) were men, and 55.0% (n = 88) were married. Ninety-six participants self-reported as having been infected with HIV through commercial heterosexual behavior and 24 were infected from their HIV-positive spouse. CRF08_BC (67.0%, n = 73) and CRF07_AE (19.3%, n = 21) were the prevalent HIV stains and formed 15 clusters at distance cutoff of 0.0025. Participants diagnosed with HIV at age ≥50, those who were divorced or bereft their spouse, or infected with HIV locally were more prevalent within the 15 molecular clusters. We identified specific venues as the primary hotspot and found that commercial heterosexual contact between older men and commercial sex workers contributed to the local HIV epidemic. In rural areas with an increasing HIV epidemic, detecting HIV transmission clusters through epidemiological and phylogenetic analysis as well as designing localized HIV prevention strategies should be prioritized.
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