The prevalence of HIV among MSM in China: a large-scale systematic analysis
The prevalence of HIV among MSM in China: a large-scale systematic analysis
复制标题
DOI：
10.1186/s12879-019-4559-1
复制
发表时间：
2019-11-27
影响因子：
3.7
通讯作者：
Chen, Jia-Jia
中科院分区：
文献类型：
--
作者：
Dong, Meng-Jie;Peng, Bin;Chen, Jia-Jia
男男性行为者（MSM）中艾滋病毒的流行已成为一项重大的公共卫生挑战。目的是通过大规模的系统分析，全面估计全国男同性恋者中艾滋病的流行情况及其时间趋势。方法系统检索Cochrane Library、PubMed、EMBASE、CNKI、VIP、万方数据库，检索2018年12月31日前发表的无语言限制的MSM人群艾滋病流行情况研究。如果研究发表在同行评议的文献中，并且使用了有效的评估方法来评估男男性接触者中艾滋病毒的流行情况，那么这些研究就有资格被纳入。使用随机效应分析汇总估计。结果数据来自355项横断面研究（571,328人），覆盖中国30个省市59个城市。从2001年到2018年，全国MSM中艾滋病毒的总体流行率估计为5.7% (95% CI: 5.4-6.1%)，研究间异质性很高（I-2 = 98.0%, P < 0.001）。我们的研究显示，随着时间的推移，HIV患病率呈上升趋势（I-2 = 95.9%, P < 0.0001）。50岁及以上人群HIV患病率最高，为19.3% （95%CI: 13.1 ~ 27.4%, N = 13）。艾滋病毒在文盲人群中（16.8%）比在受过教育的人群中更为普遍。尽管互联网是中国男男性接触者寻找男性性伴侣的主要场所（35.6,95%CI: 32.3-39.9%, N = 101），但在浴室/桑拿浴室寻找男男性接触者的艾滋病相关患病率最高（13.4,95%CI: 10.3-17.1%, N = 22）。男男性行为者的HIV感染率因地区而异：与中国其他地区相比，西南地区的男男性行为者HIV感染率最高（10.7%,95%CI: 9.3-12.2%, N = 91）。与有时或总是使用安全套的参与者相比，过去6个月内从未使用安全套的参与者感染艾滋病毒的风险更高，优势比为0.1 （95%CI: 0.08-0.14）。我们的分析提供了中国男同性恋者艾滋病负担的可靠估计，这似乎是一个日益严重的国家公共卫生挑战。需要政府作出有效的反应来应对这一挑战，并包括实施艾滋病毒预防。
Background The prevalence of HIV among men who have sex with men (MSM) has become a significant public health challenge. The aim was to comprehensively estimate the national prevalence of HIV among MSM and its time trends through a large-scale systematic analysis. Methods Systematic search of Cochrane Library, PubMed, EMBASE, CNKI, VIP, and Wanfang Data databases without language restriction for studies on the prevalence of HIV among MSM published before Dec.31, 2018. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used validated assessment methods to assess the prevalence of HIV among MSM. Estimates were pooled using random-effects analysis. Results Data were extracted from 355 cross-sectional studies (571,328 individuals) covered 59 cities from 30 provinces and municipalities of China. The overall national prevalence of HIV among MSM from 2001 to 2018 was estimated to be 5.7% (95% CI: 5.4-6.1%), with high between-study heterogeneity (I-2 = 98.0%, P < 0.001). Our study showed an increased tendency in the HIV prevalence as time progressed by meta-regression analysis (I-2 = 95.9%, P < 0.0001). HIV prevalence was the highest in those aged 50 years and older with HIV prevalence of 19.3% (95%CI: 13.1-27.4%, N = 13). HIV was more prevalent in the illiterate population (16.8%), than in those who had received an education. Although the internet was a major venue for Chinese MSM seeking male sex partners (35.6, 95%CI: 32.3-39.9%, N = 101), seeking MSM in bathhouses/saunas had the highest associated prevalence of HIV (13.4, 95%CI: 10.3-17.1%, N = 22). The HIV prevalence among MSM varied by location: compared with other regions in China, HIV was highly prevalent among MSM in the southwest (10.7, 95%CI: 9.3-12.2%, N = 91). Compared to participants who sometimes or always used condoms, participants who had never used a condom in the past 6 months had a higher risk of HIV infection, with odds ratios of 0.1 (95%CI: 0.08-0.14). Conclusions Our analysis provided reliable estimates of China's HIV burden among MSM, which appears to present an increasing national public health challenge. Effective government responses are needed to address this challenge and include the implementation of HIV prevention.