HIV risk behaviors and attitudes among Chinese men who have sex with men : a systematic review

Abstract

The HIV epidemic among men who have sex with men (MSM) has become a major public health challenge in Chinese communities. In recent decades, various studies have been conducted among Chinese MSM to understand the HIV risk behaviors and attitudes and the relationship between them. However, it is difficult to get a complete picture of the situation in Chinese population. The objective of the present systematic review is to synthesize findings on the HIV risk behaviors and attitudes among Chinese MSM. The results may facilitate the planning of HIV prevention intervention in Chinese communities. Studies of HIV risk behaviors and attitudes among Chinese MSM were identified through the search engine PubMed. At the beginning, 259 articles were searched. Some articles were primarily excluded due to obviously irrelevant to the review topic, having secondary data which are not valuable for further review, or published in languages other than English. Advanced exclusive reasons were old data collection, small sample size, fail to provide quantitative analysis, and fail to extract specific and focusing data. Articles from Taiwan were few and no Taiwan study was included in this systematic review due to the articles all failed to meet the selection criteria. Finally, 11 studies from Mainland China and Hong Kong were included after reviewing for eligibility. All 11 studies selected in this systematic review were cross-sectional studies and using quantitative survey method. Generally, the findings showed that condom nonuse among Chinese MSM was common, in both Hong Kong and Mainland. In Hong Kong, 4 studies reported about 23-30% of the MSM respondents had multiple sex partners. In Mainland, 2 studies reported high prevalence (more than 60%) of two or more sex partners. Condom use decreased with the increase of intimate level between sex partners. A study found the level of HIV risk perception of Chinese MSM was significantly positive associated with both unprotected anal intercourse and multiple partners. Small numbers of the reviewed studies reported the prevalence of substance/alcohol use before sex, or selling/ purchasing sex, both were not at a high level. The findings also indicated that the knowledge level and awareness of HIV were high in most MSM respondents in Mainland China. Two studies conducted in Hong Kong reported large proportion of the respondents perceived no chance of contracting HIV in the future. Specific public health interventions for Chinese MSM should be developed based on the weaknesses of behavioral, knowledge and awareness interventions in Mainland and Hong Kong. Overall, inconsistent condom use and multiple partners are the major problems. Evidence shows significant positive association between HIV risk perception level and the prevalence of HIV risky sexual behaviors, which is valuable for designing the behavioral interventions.