Abstract
BackgroundChina has the largest number of the elderly in the world. As the proportion of elderly is rapidly increasing among national reported HIV/AIDS cases, it is a concern about HIV epidemic among older MSM in China. However, studies on HIV prevalence and unprotected anal intercourse (UAI) among Chinese older MSM were relatively few or generally had small sample sizes.MethodsEnglish and Chinese articles published in peer-reviewed journals were identified by systematically searching 5 electronic databases including PubMed and through cross-referencing. Summary prevalence rates of HIV infection and UAI with male sexual partners were calculated, and analyses were performed using the software Comprehensive Meta-Analysis V2.0 and SPSS V17.0. Subgroup analyses were performed separately by sample size, study year, study location, recruitment settings and sampling method.ResultsTwenty eligible cross-sectional studies (3 in English and 17 in Chinese), published between 2005 and 2013, with a total of 2812 older MSM participants, were identified. Our meta-analyses showed that the prevalence of HIV, syphilis and UAI in the last 6 months were 11.6% (95% confidence interval [CI]: 8.0%-16.6%), 23.0% (95% CI: 15.8%-32.3%) and 79.5% (95% CI: 72.7%-84.9%), respectively. HIV prevalence increased over the study period (6.3% in 2003–2007; 8.6% in 2008–2009, and 11.5% in 2010–2011, trend test Chi-square = 7.02, p = 0.008). The pooled prevalence of HIV (11.6% vs. 5.2%, Chi-square value = 36.2, p < 0.001) and UAI (79.5% vs. 52.6%, Chi-square value = 440.04, p < 0.001) among older MSM were both significantly higher than among younger age group (age < 50 years).ConclusionsOlder Chinese MSM have high prevalence of HIV and syphilis. Unprotected anal sex is common and further puts them at high risks of acquiring and transmitting HIV, which was one of reasons for the rapid increasing of national reported older male HIV/AIDS cases. Prevention intervention programs should be specially tailored for this high risk MSM subgroup.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-531) contains supplementary material, which is available to authorized users.
Highlights
China has the largest number of the elderly in the world
According to a report from the Chinese Ministry of Health, it estimated that there were approximately 780,000 people living with Human immunodeficiency virus (HIV)/ Acquired immune deficiency syndrome (AIDS) in 2011 in China [3], 17.4% of the estimated HIV/ AIDS cases were attributable to male-to-male sexual contact
Inclusion and exclusion criteria Studies were eligible for inclusion in the review if they met the following criteria: (1) published in Chinese or English language; (2) conducted in China; (3) study participants aged ≥ 50 years old men who have sex with men (MSM); (4) reported homosexual behaviors; (5) presented laboratory diagnosis of HIV and/or syphilis, as well unprotected anal intercourse (UAI) which was defined as no condom use in insertive or receptive anal sex for at least once in the past 6 months
Summary
As the proportion of elderly is rapidly increasing among national reported HIV/AIDS cases, it is a concern about HIV epidemic among older MSM in China. According to a report from the Chinese Ministry of Health, it estimated that there were approximately 780,000 people living with HIV/ AIDS in 2011 in China [3], 17.4% of the estimated HIV/ AIDS cases were attributable to male-to-male sexual contact. Chinese elderly people were generally not considered as a population at high-risk for HIV infection [7]. Among nationally reported HIV/ AIDS cases, the proportion of total cases accounted for by the 50–64 age group increased from 1.6% to 13.8% in 2000 and 2011, respectively [4]
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