HIV vulnerability among older Chinese men: new perspectives
Authors: Chengmeng Zhang
Journal: The Lancet Global Health (2024)

Rui Zhao and colleagues' Article (February, 2024)1Zhao R Fairley CK Cook AR et al.Optimising HIV pre-exposure prophylaxis and testing strategies in men who have sex with men in Australia, Thailand, and China: a modelling study and cost-effectiveness analysis.Lancet Glob Health. 2024; 12: e243-e256Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar offers crucial insights into HIV transmission dynamics among men who have sex with men in Australia, Thailand, and China. The study highlights the need for tailored prevention strategies, as evidenced by its comprehensive Markov model analysis. I aim to highlight a crucial, yet often overlooked, aspect of HIV transmission dynamics: the heightened vulnerability of older Chinese men who have sex with men to HIV acquisition,2Fang EF Xie C Schenkel JA et al.A research agenda for ageing in China in the 21st century (2nd edition): focusing on basic and translational research, long-term care, policy and social networks.Ageing Res Rev. 2020; 64101174 Crossref Scopus (263) Google Scholar particularly amid unsafe sexual practices and illegal sex work. Cultural stigma around and poor awareness of homosexuality in this demographic can lead to riskier behaviours and barriers to accessing HIV testing or pre-exposure prophylaxis (PrEP), thus escalating susceptibility.3Zhu Q Huang J Wu X et al.Virologic failure and all-cause mortality among older people living with HIV/AIDS in South China.AIDS Care. 2023; 35: 1815-1820Crossref PubMed Scopus (5) Google Scholar Moreover, older men who have sex with men frequently face undiagnosed sexually transmitted infections and have infrequent health check-ups, further increasing their risk of HIV transmission. An additional concern is the participation of older adults in China's unlawful sex trade,4Chen X Qin C Chen R et al.Epidemiological profile and molecular genetic characterization of HIV-1 among female sex workers and elderly male clients in Guangxi, China.Emerg Microbes Infect. 2021; 10: 384-395Crossref PubMed Scopus (13) Google Scholar which is often overlooked due to age-related legal protections. For instance, a case in Hunan province showed that older individuals are often exempt from administrative detention,5Fangeng Z Shaoping Z Central police station security team: raid inspection of pornographic establishments and investigate a case of prostitution. WeChat, 2018https://mp.weixin.qq.com/s/EpuP0Le6a4SVqLFdLWwHSgDate accessed: January 22, 2024Google Scholar potentially encouraging them to engage with sex workers without fear of legal repercussions, and thereby elevating their risk of HIV transmission. In conclusion, although Zhao and colleagues' study provides essential guidance for optimising HIV prevention strategies among men who have sex with men, it is vital to specifically address the vulnerabilities of older Chinese men who have sex with men. Effective HIV control and prevention in this population necessitates comprehensive, age-sensitive strategies, including education on safe sex, accessible PrEP, and regular testing, all tailored to their unique needs and circumstances. I declare no competing interests. Optimising HIV pre-exposure prophylaxis and testing strategies in men who have sex with men in Australia, Thailand, and China: a modelling study and cost-effectiveness analysisExpanding oral PrEP use for MSM, with country-specific testing frequency, is cost-effective in Australia, Thailand, and China. Due to the high cost, CAB-LA is currently not affordable as a single-use strategy but might be offered as an additional option to oral PrEP. Full-Text PDF Open Access