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
Han, Larry; Wei, Chongyi; Muessig, Kathryn E et al. (2017) HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations. Glob Public Health 12:31-44
Lin, Lavinia; Brown, Katherine B; Hall, Brian J et al. (2016) Overcoming barriers to health-care access: A qualitative study among African migrants in Guangzhou, China. Glob Public Health 11:1135-47
Best, John; Tang, Weiming; Zhang, Ye et al. (2015) Sexual behaviors and HIV/syphilis testing among transgender individuals in China: implications for expanding HIV testing services. Sex Transm Dis 42:281-5
Bien, Cedric H; Best, John M; Muessig, Kathryn E et al. (2015) Gay Apps for Seeking Sex Partners in China: Implications for MSM Sexual Health. AIDS Behav 19:941-6
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
Bien, Cedric H; Muessig, Kathryn E; Lee, Ramon et al. (2015) HIV and syphilis testing preferences among men who have sex with men in South China: a qualitative analysis to inform sexual health services. PLoS One 10:e0124161
Muessig, Kathryn E; Bien, Cedric H; Wei, Chongyi et al. (2015) A mixed-methods study on the acceptability of using eHealth for HIV prevention and sexual health care among men who have sex with men in China. J Med Internet Res 17:e100
Seña, Arlene C; Zhang, Xiao-Hui; Li, Trudy et al. (2015) A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy. BMC Infect Dis 15:479
McLaughlin, Megan M; Simonson, Louis; Zou, Xia et al. (2015) African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust. PLoS One 10:e0123255
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

Showing the most recent 10 out of 56 publications