Effectiveness of control measures against human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) in China : a systematic review

Abstract

Background: Men who have sex with men (MSM) are a high risk group of human immunodeficiency virus (HIV) infection. Since 2003, HIV prevalence and incidence among MSM in China has increased alarmingly. And then numerous control measures targeting risk reduction of HIV infection among MSM have been implemented. However, previous studies varied in methodologies, prevention or interventions, and most studies only investigated one or several of control measures. Moreover, there are no existing systematic reviews on the effectiveness of integrated control measures against HIV infection. Therefore, this systematic review was conducted to assess the effectiveness of control measures against HIV infection among MSM in China, in terms of condom use, sexual behaviours, awareness of HIV knowledge, HIV counseling and testing, and HIV prevalence and incidence. Methods: A total of 154 articles were first retrieved from English database PubMed, and 114 articles from Chinese database CNKI. 19 English and Chinese articles that met the inclusion criteria were included in this systematically review. Results: The common control measures, including distribution and use of condoms and lubricant, high risk behavioural interventions, education of HIV knowledge, peer interventions, HIV testing and counseling, and MSM community or venue based interventions, are effective in increasing condom use in the anal sex, reducing risk sexual behaviours, improving awareness of HIV knowledge, and promoting the participation of HIV counseling and testing, which are all beneficial to prevent HIV infection among MSM. These findings may be influenced by the design of questions and the standard, and the response of MSM to questions. As for HIV prevalence and incidence, the effectiveness on them is uncertain, probably owing to inappropriate timing of conducting control measures, the short follow-up period, the small sample size or the scale of study. Future studies need to improve sampling method, and extend follow-up time and the study scale appropriately. Conclusion: Based on this systematic review, the control measures are effective in increasing condom use, reducing risk sexual behaviours, improving awareness of HIV knowledge and promoting the participation of HIV counseling and testing, while the effectiveness on HIV prevalence and incidence is uncertain among MSM in China. In future, more policy researches on HIV/AIDS burden, MSM and control measures are needed to provide an evidence base for policy change. In practice, policy makers and researchers need to promote structural control measures targeting different typologies of MSM. And the more effective way in conducting control measures needs the multi-sector cooperation, especially the cooperation between the governmental organizations and MSM community.