Mapping the HIV and syphilis epidemic and sexual behaviours in men who have sex with men in China: a meta-analysis

Abstract

BackgroundData from national HIV sentinel surveillance are limited for men who have sex with men (MSM) about how geographical differences and sexual behaviours in this population are associated with prevalence of HIV infection in China. Through mapping, we aimed to clarify the pattern of HIV infections in different regions by conducting a spatiotemporal meta-analysis. MethodsWe searched in PubMed and China National Knowledge Infrastructure (CNKI) using the key words “HIV”, “MSM”, “Gay”, and “China” for any studies with original data of HIV infection, which were conducted in mainland China between Jan 1, 2001, to June 8, 2016 and published in Chinese or English. Study area, study period, and sample size were included. We extracted key information on HIV and syphilis prevalence and on sexual behaviours. All studies were grouped by six study regions and four study periods. The meta-analysis was done with the meta package of R statistical software version 3.3.1. FindingsOverall, of 2119 papers screened, 272 papers were included in the meta-analysis. Of these selected papers, 83 (31%) were from east region. The sample sizes of the studies ranged from 19 to 47 231. National HIV prevalence increased from 3·80% (95% CI 3·03–4·76) in 2001–07 to 6·61% (5·65–7·71) in 2013–15. Southwest remained the region with the highest HIV prevalence (median 2001–07: 10·58%, 2008–10: 7·87%, 2011–12: 9·05%, and 2013–15: 9·23%), while northwest increased steeply to the same level as southwest over the years (median 2001–07: 5·30%, 2008–10: 4·72%, 2011–12: 6·64%, 2013–15: 9·45%). Syphilis prevalence progressively decreased across the study period from 12·34% (10·16–14·92) in 2001–07 to 7·09% (5·59–8·94) in 2013–15, the largest declines were observed in the southwest and northwest regions. There was a negative association between HIV infection and condom use with a male partner in the past month (r=–0·411, p=0·024) in 2008–15, but we did not find a significant correlation between syphilis and HIV prevalence, and between syphilis prevalence and sexual behaviours. InterpretationThe overall HIV prevalence is still increasing in China, particularly in the southwest and northwest regions. A strategy for prevention and control of HIV, especially for condom promotion, is highly expected. FundingNational Institutes of Health (National Institute of Allergy and Infectious Diseases [NIAID] 1R01AI114310); University of North Carolina (UNC)-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532); UNC Center for AIDS Research (NIAID 5P30AI050410); the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138); and National Center for Advancing Translational Sciences (UL1TR001111) at the National Institutes of Health. The listed grant funders had no role in any step of this study.