Trends in HIV prevalence and risk behaviours among men who have sex with men from 2013 to 2017 in Nanjing, China: a consecutive cross-sectional survey.

OBJECTIVE:To examine the trends of HIV prevalence, risk behaviours and HIV testing among men who have sex with men (MSM) in Nanjing. DESIGN:Five consecutive cross-sectional surveys. SETTING:Nanjing, China. PRIMARY AND SECONDARY OUTCOME MEASURES:HIV and syphilis prevalence, HIV testing rate and factors associated with HIV infection; demographic characteristics and behaviours. RESULTS:649, 669, 577, 633, 503 MSM were recruited from 2013 to 2017. HIV prevalence was 9.9%, 12.3%, 12.5%, 9.8% and 10.1%, respectively. Syphilis prevalence decreased with a range from 10.6% to 5.6%. Risk behaviours like unprotected anal intercourse (UAI) and unprotected virginal sex in the past 6 months decreased, but multiple sex partners and ever used rush popper rose significantly. MSM tested for HIV in the previous year remained stable from 57.0% to 64.1% (P=0.633). Multivariate analysis showed that tested for HIV in the past year was protective factor against HIV infection. MSM who had UAI in the past 6 months, sex role as receptive and dual, diagnosed with sexually transmitted diseases (STDs) in the past year and currently syphilis infected were risk factors for HIV infection. CONCLUSIONS:We observed stable high HIV prevalence, a steady HIV testing rate, decreasing syphilis prevalence and UAI among MSM in Nanjing. However, rush popper use rose dramatically. The HIV preventive strategies for MSM including condom promotion, HIV testing expansion and reduction of rush popper use, STDs screening and standardised treatment should be strengthened

Vertically Balanced Rate of the Basic Medical Insurance System

The unbalanced age structure aspect of China's basic medical insurance system increases payment risk and hampers sustainable and healthy development. Combining the actuarial approaches of life insurance and non-life insurance, the principle of long-term fund balance is applied to establish a model with which to calculate the vertically balanced rate of the basic medical insurance system. Analysis of data from City S indicates that the vertically balanced rate is significantly higher than the current premium rate. The vertically balanced rate increases when an older age is used for starting premium payments; the vertically balanced rate is higher for females than for males. As the investment return rate increases, the vertically balanced rate decreases. The vertically balanced rate can be used to adjust the whole-life premium rate, the minimum premium period, the minimum age of participating in the system, continuing and supplemental premiums, and benefit adjustments. It can also provide a scientific basis for policy reform in reducing the aging insured population in the medical insurance system, reduce pressure on the fund, and maintain the balance of the insurance fund.