22 Aug 2019

Plans for China/Australia sexual health centre gain momentum

by Anne Crawford
Prof. Lei Zhang, earlier in the year at the collaborative meeting
to discuss the new joint centre.

The head of the Central Clinical School, Professor Stephen Jane, will visit China next week to discuss plans for a new joint centre researching sexual health, a collaboration between Monash University and Xi'an Jiaotong University in China (XJTU).

The China-Australia Joint Research Centre for Infectious Diseases will bring together researchers from the Central Clinical School’s Melbourne Sexual Health Centre (MSHC) and School of Public Health, Xi'an Jiaotong University in north-western China.

Professor Jane will meet with Professor Yan Hong, Vice President of Xi'an Jiaotong University, to discuss collaboration between the universities’ faculties of medicine, focussing on the exchange of academic staff and students, and possible joint programs.

“This is a very exciting opportunity for Monash University and particularly the Central Clinical School, with the possibility of joint programs with Xi'an Jiaotong University in Sexual Health, and other disciplines in Health Science,” Professor Jane said. “The chance of students having shared experiences between the countries and universities is very appealing, and I look forward to wide-ranging discussions towards this end during my visit,” he said.

The centre has appointed its first staff member, Monash PhD graduate Dr Shu Su, who is now a postdoctoral researcher at XJTU. It was conceived and is being directed by the MSHC’s Professor Lei Zhang, who holds a joint appointment with Xi'an Jiaotong University’s School of Public Health.

Professor Zhang said he saw similarities in the rising epidemic of STIs such as syphilis, which both Australia and China are facing. However, there were differences in the approach to these diseases.

“There is insufficient sexual health education in China among adolescents, and the one-night stand is becoming more common,” he said.

The attitude of people towards sexual health topics in some areas, particularly inland and developing areas, was relatively conservative, he said. A hidden but rising HIV epidemic among university students existed.

“Unlike in Australia, discussion about sexual health issues especially gay sexual health is taboo in China and even among the medical health-care workers they still have a stigma towards gay people,” Professor Zhang said.

The new centre will draw on Australian experience and expertise in researching and countering HIV and sexually transmitted infections (STI). “HIV has been in Australia more than 30 years and was primarily transmitted among gay men. We have been very successful in containing the epidemic within this population,” he said.

The centre could help promote de-stigmatisation and provide the necessary access to HIV treatment and prophylaxis, he said. It could also help collate data from the STI departments in all major hospitals that may otherwise be untapped.

Strong track record of research in China

Considerable research, with some landmark findings, has previously been conducted on HIV and STIs in China by MSHC researchers including Professor Zhang, Dr Jason Ong, Associate Professor Eric Chow and Professor Fairley. Around 40 papers have been written, dating back to 2010.

A study published in Lancet Infectious Diseases in 2013 on which Professor Zhang and Dr Chow worked was the first to predict that homosexual transmission of HIV would overtake needle sharing and become the dominant mode of transmission in China.

“That gained a lot of attention and was widely cited,” Professor Zhang said.

Another study in 2011 investigating the rising epidemic of HIV among homosexual men in China cited multiple partners and bisexual behaviour as key risk factors for HIV transmission in homosexual men and the potential bridge into the general female population. BBC news cited this finding in its report of surging new HIV diagnoses in 2018.

Last year, a paper in AIDS and Behavior on which Professor Zhang was first author, predicted that PrEP (pre-exposure prophylaxis), which helps prevent HIV, was going to be very cost-effective for HIV prevention in Chinese men who have sex with men (MSM), amid scepticism and opposition to it in China.

This year, MSHC researchers were part of two important papers published in high-impact journals.

The first, which appeared in the International Journal of Epidemiology, reported on a study in Cambodia evaluating an approach that combines infection prevention procedures with routine antenatal care as a way of preventing mother-to-child transmission of HIV, HBV and syphilis. “We spent quite some time on this and got a very good result showing that prevention itself was highly cost-effective in developing countries,” Professor Zhang said.

The other paper, published in Clinical Infectious Diseases, looked at an aspect of the prevention and control of the syphilis epidemic in China. “From that study we showed that the increase in routine screenings of women during pregnancy actually reduced syphilis in women in China,” Professor Zhang said.

Another study, yet to be published, evaluates the cost-effectiveness of the first bivalent HPV vaccine that would become commercially available in China. HPV (human papillomavirus) is responsible for almost all cases of genital warts and cervical cancer, and is linked to a number of other cancers.

Australia has co-valent vaccines and national programs to vaccinate young people. “In China they don’t have this national program and the vaccines are mostly commercial so you have to go in and buy them,” Professor Zhang said. “This domestic vaccine is a great opportunity for China to develop a national HPV vaccine program. We showed it’s going to change the HPV epidemic in China dramatically.”

A broad vision to help through research

Professor Zhang is a highly experienced modeller and epidemiologist in HIV/STI research who has established strong collaborations in the past with national health institutes, including CDCs (Chinese Center for Disease Control and Prevention) and international organisations including WHO, UNAIDS and the World Bank.

Born in China, he moved to Australia at the age of 14. Professor Zhang was inspired to help marginalised people such as those with HIV after seeing the devastation caused to communities in Sichuan Province following huge earthquakes in 2008.

“At the time I was doing my post-doctoral year and was touched by that experience,” he said. “I have a very broad vision of not only doing research in Australia and helping the Australian population but doing research across borders, especially in developing countries.”



Zhang, L., et al., Integrated approach for triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis is highly effective and cost-effective: an economic evaluation. Int J Epidemiol, 2019 Mar 16. pii: dyz037. doi: 10.1093/ije/dyz037. [Epub ahead of print]

Tao, Y., et al., A Nationwide Spatiotemporal Analysis of Syphilis over 21 Years and Implications for Prevention and Control in China. Clinical Infectious Diseases, 2019 Apr 26. pii: ciz331. doi: 10.1093/cid/ciz331. [Epub ahead of print]

Zhang L, Chow EPF, Jing J, et al. HIV prevalence in China: integration of surveillance data and a systematic review. The Lancet Infectious Diseases 2013; 13(11): 955-63.

Zhang L, Peng P, Wu Y, et al. Modelling the Epidemiological Impact and Cost-Effectiveness of PrEP for HIV Transmission in MSM in China. AIDS Behav, 2019 Feb;23(2):523-533. doi: 10.1007/s10461-018-2205-3.

Chow, E.P., D.P. Wilson, and L. Zhang. What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis. BMC Infect Dis, 2011. 11: p. 242.

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