High prevalence of HIV infection and unprotected anal intercourse among older men who have sex with men in China: a systematic review and meta-analysis

BMC Infectious Diseases

Hong Shang⁴  Wen-qing Geng⁴  Yong-jun Jiang⁴  Shu-yang Liu⁴  Zhen-xing Chu⁴  Qing-hai Hu⁴  Jian-ming Zhang³  Jing Zhang⁴  Bing-xin You²  Han-zhu Qian¹  Jun-jie Xu⁴  Yong-ze Li⁴ 

[1] Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA;Department of Finance, Business College, Washington State University, Pullman, WA, USA;Department of Clinical Epidemiology and Evidence-based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China;Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China

关键词: China;    Older MSM;    Men who have sex with men (MSM);    Unprotected anal intercourse (UAI);    Syphilis;    HIV;   

Others  :  1125444
DOI  :  10.1186/1471-2334-14-531

 received in 2014-04-03, accepted in 2014-09-16,  发布年份 2014

【 摘 要 】

Background

China 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.

Methods

English 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.

Results

Twenty 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).

Conclusions

Older 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.

【 授权许可】

   
2014 Li et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Zhang L, Chow EP, Jing J, Zhuang X, Li X, He M: HIV prevalence in China: integration of surveillance data and a systematic review. Lancet Infect Dis 2013, 13:955-63.
• [2]Wu Z, Xu J, Liu E, Mao Y, Xiao Y, Sun X: HIV and syphilis prevalence among men who have sex with men: a cross-sectional survey of 61 cities in China. Clin Infect Dis 2013, 57:298-309.
• [3]State Council AIDS Working Committee Office: A joint assessment of HIV/AIDS prevention, treatment and care in China. [Available: http://www.chinaids.org.cn webcite]
• [4]Ministry of Health, People’s Republic of China: 2012 China AIDS Respons Progress Report. [http://www.unaids.org.cn/cn/index/page.asp?id=197&class=2&classname=China’s+Epidemic+%26+Response+ webcite]
• [5]China National Committee On Ageing: China's aging population will exceed 200 million at the end of 2013. [http://finance.chinanews.com/jk/2012/09-05/4160829.shtml webcite]
• [6]Wu YS: Annual Report on Development of the Cause of Aging. Beijing, China: Social Science Academic Press; 2013.
• [7]Zou H, Wu Z, Yu J, Li M, Ablimit M, Li F: Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Beijing and Urumqi, China. J Acquir Immune Defic Syndr 2010, 53:81.
• [8]Biyun Q, Xi C, Yujun Y, Qi L, Jie L, Xianguo S: Qualitative study on HIV-related information in senile HIV-positives in Hunan. China Trop Med 2012, 12:677-678,687.
• [9]Guangzi Q, Yaqin P: Survey of cognitive attitude of medium-elderly men to AIDS in area with high incidence of AIDS. Chin J Gerontol 2012, 32:784-785.
• [10]Jie L, Xi C, Biyun T, Wenbo H, Wenjuan Z: Investigation of HIV-related risk factors among elderly HIV-positive patients. Pract Prev Med 2010, 17:227-229.
• [11]Zhu M, Zhang B, Li X, Shi T, Wu S: The Relationship of Age and High Risk Behaviors Related to HIV, AIDS among Men Who Have Sex with Men in China. Chin J Drmatol 2004, 37:635-637.
• [12]Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010, 8:336-341.
• [13]Wong WC, Cheung CS, Hart GJ: Development of a quality assessment tool for systematic reviews of observational studies (QATSO) of HIV prevalence in men having sex with men and associated risk behaviours. Emerg Themes Epidemiol 2008, 5:23. BioMed Central Full Text
• [14]Lipsey MW, Wilson DB: Practical Meta-analysis. Thousand Oaks, California: Sage Publications; 2001.
• [15]Hunter JE, Schmidt FL, Jackson GB: Meta-analysis: Cumulating research findings across studies. Thousand Oaks, California: Sage Publications; 1982.
• [16]Aibing M, An Xiaojing Y, Huifang ZY, Zhimin Y: The analysis of 78 cases with HIV infection test results among men who have sex with men in Yunnan. Chin J AIDS STD 2007, 13:60-61.
• [17]Xi S: Study on AIDS Prevention knowledge, behavioral characteristics, HIV infection and its influencing factors among men who have sex with men(MSM)in Hangzhou City. PhD thesis. Zhejiang University: Department of Social Medicine & Health Management; 2011.
• [18]Qingping L, Peilan Q, Zhenhao H, Jian C, Weilv W: Survey on a Cluster of HIV Infection Among MSMs in a Club and Exploration of its Influencing Factors. Pract Prev Med 2012, 19:1903-1906.
• [19]Zhou JB, Hao C, Huan XP, Wang JT, Zhen S: HIV and syphilis infections among men who have sex with men. Chin J Public Health 2012, 28:1031.
• [20]Wang Z: A survey of HIV infections and related factors among men who have sex with men in Xining Qinghai province. PhD thesis. Shanxi Medical University; 2012.
• [21]He Q, Wang Y, Lin P, Liu Y, Yang F, Fu X: Potential bridges for HIV infection to men who have sex with men in Guangzhou, China. AIDS Behav 2006, 10:17-23.
• [22]Zhenxing C, Ma Ning X, Junjie ZM, Qinghai H, Zhang J: HIV prevalence and its associated factors among 2074 men who have sex with men (MSM) in Liaoning province, China. Chin J Public Health 2011, 27:967-969.
• [23]Xiao Y, Sun J, Li C, Lu F, Allen KL, Vermund SH: Prevalence and correlates of HIV and syphilis infections among men who have sex with men in seven provinces in China with historically low HIV prevalence. JAIDS 2010, 53:S66-S73.
• [24]Yanqiu Z, Jie G, Kaikan G, Hui W, Xiaolong M: Testing of HIV and Syphilis and Investigation of Risk Factors Among 416 MSM. Chinese Prim Health Care 2012, 26:11.
• [25]Luguang Y, Xiuping S, Xinping D, Liang S, Duan Y: Study On AIDS Knowledge, Behavior And HIV infection Among MSM In Fuyang Of Anhui Province. Anhui J Prev Med 2012, 18:22-23.
• [26]Gunghua L, Wei L, Qiuying Z, Fuxiong L, Yuman H: Surveillance of HIV Infection Among Different Aged Men Having Sex With Men in Guangxi. J Prev Med Inf 2009, 25:608-611.
• [27]Feng F, Wang Z, Huang S, Lv J, Lin Z: Investigation on AIDS knowledge, attitude and practice characteristics of MSM group and HIV/syphilis infection situation. Mod Prev Med 2009, 36:2902-2903.
• [28]Fuxin Z, Xiuping Z, Xiaoping C, Yanqiu Z, Guangjie C: Sero-prevalence and correlates of HIV infection among men who have sex with men in Suzhou. Chin J Dis Control Prev 2011, 15:1031-1034.
• [29]Rui L, Wei T, Zhijie Z: Survey on HIV Infection and Related Factors and High Risk Behaviors among Men who Have Sex with Men in Dalian City, 2009. Prev Med Trib 2010, 16:1127-1129.
• [30]Yang C, Limei S, Yongming Y, Jian Z, Fei Y: HIV/AIDS epidemic among 1045 MSMs and the associated factors in two cities of Guizhou. Chin J AIDS STD 2013, 06:402-405+412.
• [31]Zhimin N, Li Jian X, Dange ZY, Ting C: An Investigation on the Infection Rate of Syphilis and HIV among MSM Population from Public Bath. Zhejiang Prev Med 2011, 23:14-16.
• [32]Xu J, Han D, Liu Z, Ma X, Wang L, Xu J: The prevalence of HIV infection and the risk factors among MSM in 4 cities. China Chin J Prev Med 2010, 44:975-980.
• [33]Luxiang Z, Jincai Q, Qianjin C: The surveillance of HIV infection and sexual behaviors amon MSM in Longyan, 2010–2011. Strait J Prev Med 2012, 18:34-35.
• [34]Zhoubin X, Huimin H, Yun H, Hui T, Zongxia Z: Sexual characteristics and HIV and syphilis infections among 98 MSM in Yangpu District, Shanghai. Chin J Dis Control Prev 2012, 16:1028-1031.
• [35]Meiying C, Chenghua G, Liping D, Yihai J, Fan W: Sexual behaviors and HIV/syphilis infection among 435 men who have sex with men. South China J Prev Med 2010, 36:28-30.
• [36]Xiaoyan M, Willi MF, Qiyun Z, Jinkou Z, Xiong H: Analysis on trend of HIV prevalence among men having sex wtih men. Chin J Public Health 2007, 23:1352-1354.
• [37]Zou H, Hu N, Xin Q, Beck J: HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav 2012, 16:1717-28.
• [38]Catania JA, Osmond D, Stall RD, Pollack L, Paul JP, Blower S: The continuing HIV epidemic among men who have sex with men. Am J Public Health 2001, 91:907.
• [39]Marcus U, Hickson F, Weatherburn P, Schmidt AJ, the EMIS network: Age biases in a large HIV and sexual behaviour-related internet survey among MSM. BMC Public Health 2013, 13:1-11. BioMed Central Full Text
• [40]Gao L, Zhang L, Jin Q: Meta-analysis: prevalence of HIV infection and syphilis among MSM in China. Sex Transm Infect 2009, 85:354-358.
• [41]Weinstock H, Sweeney S, Satten GA, Gwinn M: HIV seroincidence and risk factors among patients repeatedly tested for HIV attending sexually transmitted disease clinics in the United States, 1991 to 1996. J Acquir Immune Defic Syndr Hum Retrovirol 1998, 19:506-512.
• [42]Otten MW Jr, Zaidi AA, Peterman TA, Rolfs RT, Witte JJ: High rate of HIV seroconversion among patients attending urban sexually transmitted disease clinics. AIDS 1994, 8:549-53.
• [43]Ruan Y, Li D, Li X, Qian H, Shi W, Zhang X: Relationship between syphilis and HIV infections among men who have sex with men in Beijing, China. Sex Transm Dis 2007, 34:592-597.
• [44]Xu JJ, Zhang M, Brown K, Reilly K, Wang H, Hu QH: Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China. Sex Transm Dis 2010, 37:432-439.
• [45]Wang Yi X, Jie LZ, Guanggui Z, Liulin L: The use of condoms among MSM and the influencing factors. Chin J Dis Control Prev 2012, 16:133-136.
• [46]Dolcini MM, Catania JA, Stall RD, Pollack L: The HIV epidemic among older men who have sex with men. JAIDS 2003, 33:S115-S121.
• [47]Li Y, Xu J, Reilly KH, Zhang J, Wei H, Jiang Y: Prevalence of HIV and syphilis infection among high school and college student MSM in China: a systematic review and meta-analysis. PLoS One 2013, 8:e69137.
• [48]Chow EP, Wilson DP, Zhang J, Jing J, Zhang L: Human immunodeficiency virus prevalence is increasing among men who have sex with men in China: findings from a review and meta-analysis. Sex Transm Dis 2011, 38:845-57.
• [49]Tesfaye DY, Kinde S, Medhin G, Megerssa YC, Tadewos A, Tadesse E: Burden of metabolic syndrome among HIV-infected patients in Southern Ethiopia. Diabetes Metab Syndr 2014, 8:102-7.
• [50]Vigouroux C, Gharakhanian S, Salhi Y, Nguyen TH, Chevenne D, Capeau J: Diabetes, insulin resistance and dyslipidaemia in lipodystrophic HIV-infected patients on highly active antiretroviral therapy (HAART). Diabetes Metab 1999, 25:225-32.
• [51]Fang W: Increasing HIV infections among MSM and the elderly. [http://news.sina.com.cn/c/2012-11-30/031925695231.shtml webcite]
• [52]Crepaz N, Marks G, Liau A, Mullins MM, Aupont LW, Marshall KJ: Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS 2009, 23:1617-1629.
• [53]Qin X, Fan L, Hao Z, Ye Y: Analysis of HIV/AIDS Prevalence of the Older Persons in China. Population & Economics 2005, 6:1-5.
• [54]Li Q: The rapid prevalence of HIV among older men and the diversification among AIDS patients in China. [http://news.xinhuanet.com/2012-08/23/c_112814803.htm webcite]
• [55]Cao Z, Zhang H, Shen M, Wang J, Xu J: Prevalence of HIV infection and sexual behaviors with both men and women among currently married men who have sex with men. Chin J Epidemiol 2012, 33:488-491.
• [56]Shang H, Xu J, Han X, Li JS, Arledge KC, Zhang L: HIV prevention: Bring safe sex to China. Nature 2012, 485:576-577.