Sexually transmitted infection (STI) patients co-infected with syphilis and HIV have some of the highest HIV transmission probabilities, yet many STI patients often never receive screening for either of these frequently asymptomatic STIs. This KOI application details a four year plan focused on implementing integrated syphilis/HIV services in South China, a region characterized by hyper endemic syphilis transmission and increasing sexual HIV transmission. Linking clinical epidemiology and social science methods, the research and training plan will be mentored by Dr. Myron S. Cohen (Infectious Diseases), Dr. Xiang-Sheng Chen (Epidemiology), and Dr. Martin K. Whyte (Sociology). The training component will include advanced coursework on clinical epidemiology, anthropology, and Mandarin Chinese to complete a Masters in Regional Studies East Asia (MRSEA) at Harvard. As an Infectious Disease Fellow at the Massachusetts General Hospital, I completed a preliminary study that found HIV to be independently associated with syphilis infection at STI clinics in South China. Syphilis test acceptance at STI clinics was greater than 90%, but HIV testing acceptance was poor. Responding to South China's expanding syphilis epidemic, the WHO has launched a pilot program in two cities providing free rapid syphilis testing at select STI clinics, introducing a special opportunity for parallel HIV operational research. Transitioning to the Massachusetts General Hospital faculty with my mentor's support, I will focus on the following three specific aims: 1) To analyze STI patient characteristics that correlate to accepting HIV testing at STI clinics;2) To describe the social and cultural context of HIV testing STI patients using qualitative methods;3) To assess STI physician characteristics that correlate to offering HIV testing. The proposed training and research program will provide a foundation to understand the complex biosocial fabric of rapidly evolving sexual health behaviors in China, uniquely positioning me as a junior investigator to implement novel behavioral responses to the twin epidemics of syphilis and HIV in China.

Public Health Relevance

Scaling up integrated HIV services is a global health priority of the first order. Approximately 90% of new syphilis cases globally are in low income areas where sexually transmitted HIV is also a major public health problem, but there have been few studies systematically analyzing integration of syphilis and HIV testing. The ultimate goal of this research is to determine optimal systems for integrated syphilis/HIV testing at STI clinics in South China

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Scientist Development Award - Research & Training (K01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-ICP2-B (51))
Program Officer
Jessup, Christine
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of North Carolina Chapel Hill
Internal Medicine/Medicine
Schools of Medicine
Chapel Hill
United States
Zip Code
Lin, Lavinia; Brown, Katherine B; Yu, Fan et al. (2015) Health Care Experiences and Perceived Barriers to Health Care Access: A Qualitative Study Among African Migrants in Guangzhou, Guangdong Province, China. J Immigr Minor Health 17:1509-17
Lee, Ramon; Cui, Rosa R; Muessig, Kathryn E et al. (2014) Incentivizing HIV/STI testing: a systematic review of the literature. AIDS Behav 18:905-12
Tucker, Joseph D; Bien, Cedric H; Easterbrook, Philippa J et al. (2014) Optimal strategies for monitoring response to antiretroviral therapy in HIV-infected adults, adolescents, children and pregnant women: a systematic review. AIDS 28 Suppl 2:S151-60
Tan, Nicholas X; Tan, Grace X; Yang, Li-Gang et al. (2014) Temporal trends in syphilis and gonorrhea incidences in guangdong province, china. J Infect Dis 209:426-30
Wei, Chongyi; Muessig, Kathryn E; Bien, Cedric et al. (2014) Strategies for promoting HIV testing uptake: willingness to receive couple-based and collective HIV testing among a cross-sectional online sample of men who have sex with men in China. Sex Transm Infect 90:469-74
Muessig, Kathryn E; McLaughlin, Megan M; Nie, Jing Min et al. (2014) Suboptimal antiretroviral therapy adherence among HIV-infected adults in Guangzhou, China. AIDS Care 26:988-95
Han, Larry; Bien, Cedric H; Wei, Chongyi et al. (2014) HIV self-testing among online MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr 67:216-21
McLaughlin, Megan M; Lee, Margaret C; Hall, Brian J et al. (2014) Improving health services for African migrants in China: A health diplomacy perspective. Glob Public Health 9:579-89
Tucker, Joseph D; Young, Darwin; Yang, Ligang et al. (2013) Social determinants of syphilis in South China: the effect of sibling position on syphilis and sexual risk behaviours. BMJ Open 3:
Tucker, Joseph D; Bien, Cedric H; Peeling, Rosanna W (2013) Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 26:73-9

Showing the most recent 10 out of 38 publications