HIV incidence and associated risk factors in men who have sex with men in Mainland China: an updated systematic review and meta-analysis
Wei Zhang A B , Jun-Jie Xu A B , Huachun Zou C , Jing Zhang A B , Ning Wang A D E and Hong Shang A B E
+ Author Affiliations
- Author Affiliations
A Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning, 110001, China.
B Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, No.79, Qingchun Road, Hangzhou, Zhejiang, 310003, China.
C Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
D National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No.155, Changbai Road, Beijing 102206, China.
E Corresponding authors. Email: hongshang100@hotmail.com; wangnbj@163.com
Sexual Health 13(4) 373-382 https://doi.org/10.1071/SH16001
Submitted: 2 November 2015 Accepted: 15 March 2016 Published: 26 May 2016
Abstract
Background: The national annually reported proportion of men who have sex with men (MSM) among people living with HIV (PLWH) is growing in China. To better inform the public health sector how to improve HIV prevention strategies, it is necessary to understand the current level of HIV incidence and its correlates. Methods: Google Scholar, PubMed, Web of Science and three major Chinese electronic publication databases (http://qikan.cqvip.com/, http://g.wanfangdata.com.cn/, http://www.cnki.net/, respectively) were searched for studies reporting HIV incidence. Comprehensive Meta-Analysis (CMA) 2.0 statistical software (Biostat, Inc. Englewood, NJ, USA) was used to calculate the pooled HIV incidence and perform subgroup-analysis to find correlates for HIV seroconversion in Chinese MSM. Random effects modelling was then conducted. Results: Twenty-five eligible studies were included in this meta-analysis. The calculated pooled HIV incidence was 5.61/100 person years (PY), with an increasing trend over time (3.24/100PY, 5.29/100PY, 5.50/100PY in 2005–2008, 2009–2011, 2012–2014 respectively, χ2 test for trend P = 0.04). Subgroup analyses indicated that age <25 years (rate ratio (RR) = 1.85), junior college education and below (RR = 1.87), having ≥ 2 male sexual partners in past 6 months (RR = 2.50), baseline syphilis infection (RR = 2.99), homosexual orientation (RR = 1.91), preferred bottom/versatile roles in anal sexual intercourse (RR = 2.33), and having unprotected anal intercourse in the past 6 months (RR = 2.16) significantly increased the risk for HIV seroconversion (each P < 0.05). Uncircumcised MSM had a marginal statistically significant higher HIV incidence (RR = 3.35, P = 0.051). Conclusion: HIV incidence is still alarmingly high among Chinese MSM. Stronger HIV intervention strategies should be implemented, in particular targeting young, less educated and syphilis-infected MSM.
Additional keywords: HIV intervention, MSM.
References
[1] Chinese Ministry of Health. Reports on the Epidemic of AIDS in 2011, Chinese Ministry of Health, Beijing, China, 2011. Chin J AIDS STD 2012; 18 1–5.[2] Chinese Center for Disease Control and Prevention. Update on the AIDS/STD epidemic in China and main response in control and prevention in December, 2014. Chin J AIDS STD 2015; 21 87
[3] Feng L, Ding X, Lu R, Liu J, Sy A, Ouyang L, et al High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China’s largest municipality: an alarming epidemic in Chongqing, China. J Acquir Immune Defic Syndr 2009; 52 79–85.
| High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China’s largest municipality: an alarming epidemic in Chongqing, China.Crossref | GoogleScholarGoogle Scholar | 19448559PubMed |
[4] Ma X, Zhang Q, He X, Sun W, Yue H, Chen S, et al Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. J Acquir Immune Defic Syndr 2007; 45 581–7.
| Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006.Crossref | GoogleScholarGoogle Scholar | 17577125PubMed |
[5] National Health and Family Planning Commission of The People’s Republic of China. 2014 China AIDS Response Progress Report, National Health and Family Planning Commission of The People’s Republic of China. 2014. Available online at: http://www.unaids.org.cn/en/index/Document_view.asp?id=859 [verified June 2014].
[6] Janssens W, van der Gaag J, Rinke de Wit TF, Tanovic Z. Refusal bias in the estimation of HIV prevalence. Demography 2014; 51 1131–57.
| Refusal bias in the estimation of HIV prevalence.Crossref | GoogleScholarGoogle Scholar | 24788481PubMed |
[7] Li H-M, Peng R-R, Li J, Yin Y-P, Wang B, Cohen MS, et al HIV incidence among men who have sex with men in China: a meta-analysis of published studies. PLoS One 2011; 6 e23431
| HIV incidence among men who have sex with men in China: a meta-analysis of published studies.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXht1Sqt73K&md5=52f2102ddd33818eddb31226724d2c5eCAS | 21887251PubMed |
[8] Feng Y, Bu K, Li M, Zhang X, Jin S, Wang L. [Meta-analysis of HIV infection incidence and risk factors among men who have sex with men in China]. Zhonghua liu xing bing xue za zhi 2015; 36 752–8.
| 26564708PubMed |
[9] Duong YT, Qiu MF, De AK, Jackson K, Dobbs T, Kim AA, et al Detection of Recent HIV-1 Infection Using a New Limiting-Antigen Avidity Assay: Potential for HIV-1 Incidence Estimates and Avidity Maturation Studies. Plos One 2012; 7 e33328
| Detection of Recent HIV-1 Infection Using a New Limiting-Antigen Avidity Assay: Potential for HIV-1 Incidence Estimates and Avidity Maturation Studies.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xlt1Cntrk%3D&md5=4cd763dcd9db483d76a32461226d572fCAS | 22479384PubMed |
[10] Guy R, Gold J, Calleja JMG, Kim AA, Parekh B, Busch M, et al Accuracy of serological assays for detection of recent infection with HIV and estimation of population incidence: a systematic review. Lancet Infec Dis 2009; 9 747–59.
| Accuracy of serological assays for detection of recent infection with HIV and estimation of population incidence: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[11] Hargrove JW, Humphrey JH, Mutasa K, Parekh BS, McDougal JS, Ntozini R, et al Improved HIV-1 incidence estimates using the BED capture enzyme immunoassay. AIDS 2008; 22 511–18.
| Improved HIV-1 incidence estimates using the BED capture enzyme immunoassay.Crossref | GoogleScholarGoogle Scholar | 18301064PubMed |
[12] Hargrove JW. BED estimates of HIV incidence must be adjusted. AIDS 2009; 23 2061–2.
| BED estimates of HIV incidence must be adjusted.Crossref | GoogleScholarGoogle Scholar | 19755864PubMed |
[13] Stang A. Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25 603–5.
| Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.Crossref | GoogleScholarGoogle Scholar | 20652370PubMed |
[14] Zhang L, Wang YJ, Wang BX, Yan JW, Wan YN, Wang J. Prevalence of HIV-1 subtypes among men who have sex with men in China: a systematic review. Int J STD AIDS 2015; 26 291–305.
| Prevalence of HIV-1 subtypes among men who have sex with men in China: a systematic review.Crossref | GoogleScholarGoogle Scholar | 25033880PubMed |
[15] Chow EP, Tucker JD, Wong FY, Nehl EJ, Wang Y, Zhuang X, et al Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis. PLoS One 2014; 9 e89959
| Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis.Crossref | GoogleScholarGoogle Scholar | 24587152PubMed |
[16] Song F, Khan KS, Dinnes J, Sutton AJ. Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy. Int J Epidemiol 2002; 31 88–95.
| Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy.Crossref | GoogleScholarGoogle Scholar | 11914301PubMed |
[17] Li DL, Jia YJ, Ruan YH, Liu YJ, Li QC, Liang HY, et al Correlates of incident infections for HIV, syphilis, and hepatitis B virus in a cohort of men who have sex with men in Beijing. AIDS Patient Care STDS 2010; 24 595–602.
| Correlates of incident infections for HIV, syphilis, and hepatitis B virus in a cohort of men who have sex with men in Beijing.Crossref | GoogleScholarGoogle Scholar |
[18] Li DL, Li SM, Liu YJ, Gao YJ, Yu MR, Yang XY, et al HIV incidence among men who have sex with men in Beijing: a prospective cohort study. BMJ Open 2012; 2 e001829
| HIV incidence among men who have sex with men in Beijing: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar |
[19] Mao HY, Ma WZ, Lu HY, Wang L, Zheng H, Zhu YY, et al High incidence of HIV and syphilis among migrant men who have sex with men in Beijing, China: a prospective cohort study. BMJ Open 2014; 4 e005351
| High incidence of HIV and syphilis among migrant men who have sex with men in Beijing, China: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar |
[20] Tang WM, Babu GR, Li JJ, Zhang Y, Fu GF, Huan XP, et al The difference between HIV and syphilis prevalence and incidence cases: results from a cohort study in Nanjing, China, 2008–2010. Int J STD AIDS 2014; 26 648–55.
| The difference between HIV and syphilis prevalence and incidence cases: results from a cohort study in Nanjing, China, 2008–2010.Crossref | GoogleScholarGoogle Scholar |
[21] Wang QQ, Chen XS, Yin YP, Liang GJ, Zhang RL, Jiang N, et al HIV prevalence, incidence and risk behaviours among men who have sex with men in Yangzhou and Guangzhou, China: a cohort study. J Int AIDS Soc 2014; 17 18849
| HIV prevalence, incidence and risk behaviours among men who have sex with men in Yangzhou and Guangzhou, China: a cohort study.Crossref | GoogleScholarGoogle Scholar | 25103308PubMed |
[22] Xu JJ, An MH, Han XX, Jia MH, Ma YL, Zhang M, et al Prospective cohort study of HIV incidence and molecular characteristics of HIV among men who have sex with men (MSM) in Yunnan Province, China. BMC Infect Dis 2013; 13 3
| Prospective cohort study of HIV incidence and molecular characteristics of HIV among men who have sex with men (MSM) in Yunnan Province, China.Crossref | GoogleScholarGoogle Scholar |
[23] Xu JJ, Zhang M, Brown K, Reilly K, Wang HL, Hu QH, et al Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China. Sex Transm Dis 2010; 37 432–9.
| Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China.Crossref | GoogleScholarGoogle Scholar | 20375928PubMed |
[24] Yan HJ, Yang HT, Zhao JK, Wei CY, Li JJ, Huan XP, et al Long-chain peer referral of men who have sex with men: a novel approach to establish and maintain a cohort to measure HIV incidence, Nanjing, China. J Acquir Immune Defic Syndr 2012; 59 177–84.
| Long-chain peer referral of men who have sex with men: a novel approach to establish and maintain a cohort to measure HIV incidence, Nanjing, China.Crossref | GoogleScholarGoogle Scholar |
[25] Yang HT, Tang WM, Xiao ZP, Jiang N, Mahapatra T, Huan XP, et al Worsening epidemic of HIV and syphilis among men who have sex with men in Jiangsu Province, China. Nephrol Dial Transplant 2014; 58 1753–9.
| Worsening epidemic of HIV and syphilis among men who have sex with men in Jiangsu Province, China.Crossref | GoogleScholarGoogle Scholar |
[26] Li SM, Zhou ZH, Jiang SL, Liu YJ, Li DL, Zhang Z, et al Incidence and risk factors of HIV and syphilis seroconversion among men who have sex with men in Beijing. Chin J Prev Med 2011; 45 118–22.
| Incidence and risk factors of HIV and syphilis seroconversion among men who have sex with men in Beijing.Crossref | GoogleScholarGoogle Scholar |
[27] Fu ZH, Zhao XP, Cao XP, Zhao YQ, Zhang FX, Shao MC. HIV incidence among men who have sex with men in Suzhou city: a cohort study. Chin J Publ Health 2014; 30 726–8.
[28] Gao YJ, Luo FJ. HIV/AIDs prospective cohort study among men who have sex with men in Beijing. Masters thesis, Hebei Medical University; 2012.
[29] Lan GH, Liang H. The HIV infection rate and its influence factors in a baseline survey among MSM in Nanning city. Doctoral thesis; Guangxi Medical University; 2011.
[30] Li XT, Luo Y, Wu HB, Jin J, Xu K. A prospective cohort study on positive seroconversion of HIV and Treponema pallidum antibodies among men who have sex with men in Hangzhou. Dis Surveill 2013; 28 280–3.
| A prospective cohort study on positive seroconversion of HIV and Treponema pallidum antibodies among men who have sex with men in Hangzhou.Crossref | GoogleScholarGoogle Scholar |
[31] Qi X, Luo FJ. HIV infection and testing of regular sex partners among men who have sex with men in Beijing. Masters thesis, Hebei Medical University; 2013.
[32] Ren HQ. Prospective cohort study among men who have sex with men (MSM) in Urumqi. Masters thesis, Xinjiang Medical University; 2012.
[33] Sun YM, Lu L. HIV incidence and influential factors of unprotected anal sexual intercourse among men who have sex with men in Kunming. Masters thesis, Kunming Medical University; 2014.
[34] Tang HL, Hu YQ, Wang FY. Changes of high-risk behaviors and HIV seroconversion in a prospective MSM cohort in Jinhua. Chin J AIDS & STD 2014; 763–5.
[35] Zhang M, Yan HJ, Wang N, Wu SS, Li JQ. Incidence of HIV infection, retention rate in a prospective cohort among men who have sex with men in Nanjing. Chin J Dis Control Prev 2011; 15 839–42.
[36] Zhang RZ, Zhang WY, Li Y-f, Wang L, Pan SF, Wang Y, et al HIV incidence among men who have sex with men in Kunming city: a cohort study. Chin J Prev Med 2012; 46 955–7.
[37] Zhao J, Cai WD, Chen ZD, Liu SC, Zhang Y, Gan YX, et al A prospective cohort study on HIV, syphilis and HCV seroconversion among men who have sex with men in Shenzhen. Chin J AIDS & STD 2011; 17 530–2.
[38] Zhao T, Shi JC, Chen FF, Ding L, Li XJ, Zhang Y, et al Study on incidence of new HIV infection among men who have sex with men in Nanyang. Chin J AIDS & STD 2013; 19 39–42.
[39] Wang Y, Li LL, Xu J, Li ZJ, Zhang GG, Fan J, et al A cohort study of new HIV infections among men who have sex with men in Mianyang city, Sichuan province of China. Chin J Viral Dis 2014; 4 218–25.
[40] Feng LG, Ding XB, Lu RR, Pan CB, Yi HR, Liu HH, et al Study on HIV-1 seroconversion rate and its associated factors among men who have sex with men in Chongqing City. Zhonghua Yu Fang Yi Xue Za Zhi 2008; 42 870–4.
| 19141218PubMed |
[41] Qin O, Zhou J, Yuan F, Dong B, Zhang Y, Yao YM, et al HIV prevalence, associated risk factors and HIV incidence among MSM in Guiyang, China. Chin J Dermatovenereology 2013; 27 1261–3.
[42] van Griensven F, Thienkrua W, McNicholl J, Wimonsate W, Chaikummao S, Chonwattana W, et al Evidence of an explosive epidemic of HIV infection in a cohort of men who have sex with men in Thailand. AIDS 2013; 27 825–32.
| Evidence of an explosive epidemic of HIV infection in a cohort of men who have sex with men in Thailand.Crossref | GoogleScholarGoogle Scholar | 23169330PubMed |
[43] Gough E, Kempf MC, Graham L, Manzanero M, Hook EW, Bartolucci A, et al HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis. BMC Public Health 2010; 10 777
| HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 21176146PubMed |
[44] Zhang L, Chow EP, Jahn HJ, Kraemer A, Wilson DP. High HIV prevalence and risk of infection among rural-to-urban migrants in various migration stages in China: a systematic review and meta-analysis. Sex Transm Dis 2013; 40 136–47.
| High HIV prevalence and risk of infection among rural-to-urban migrants in various migration stages in China: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXitVKktbjF&md5=9a96afbb63686de0bc2c3626885398b1CAS | 23321993PubMed |
[45] Pathela P, Braunstein SL, Schillinger JA, Shepard C, Sweeney M, Blank S. Men who have sex with men have a 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in New York City. J Acquir Immune Defic Syndr 2011; 58 408–16.
| Men who have sex with men have a 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in New York City.Crossref | GoogleScholarGoogle Scholar | 21857351PubMed |
[46] Dong Z, Xu J, Zhang H, Dou Z, Mi G, Ruan Y, et al HIV incidence and risk factors in Chinese young men who have sex with men – a prospective cohort study. PLoS One 2014; 9 e97527
| HIV incidence and risk factors in Chinese young men who have sex with men – a prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 24878586PubMed |
[47] UNAIDS. A guidance note prepared by the inter-agency task team on HIV and young people (IATT/YP): HIV prevention, treatment, care and support for adolescents and youth. 2014. Available online at: http://www.unaids.org/sites/default/files/media_asset/2014_guidance_HIVservices_adolescents_youth_en.pdf [verified May 2014].
[48] Pettifor A, Bekker LG, Hosek S, DiClemente R, Rosenberg M, Bull SS, et al Preventing HIV among young people: research priorities for the future. J Acquir Immune Defic Syndr 2013; 63 S155–60.
| Preventing HIV among young people: research priorities for the future.Crossref | GoogleScholarGoogle Scholar | 23764629PubMed |
[49] Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet 2008; 372 669–84.
| Behavioural strategies to reduce HIV transmission: how to make them work better.Crossref | GoogleScholarGoogle Scholar | 18687459PubMed |
[50] Dokubo EK, Kim AA, Le LV, Nadol PJ, Prybylski D, Wolfe MI. HIV incidence in Asia: a review of available data and assessment of the epidemic. AIDS Rev 2013; 15 67–76.
| 23681434PubMed |
[51] Buchacz K, Greenberg A, Onorato I, Janssen R. Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States: implications for HIV prevention. Sex Transm Dis 2005; 32 S73–9.
| Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States: implications for HIV prevention.Crossref | GoogleScholarGoogle Scholar | 16205297PubMed |
[52] Ostrow DG, Plankey MW, Cox C, Li X, Shoptaw S, Jacobson LP, et al Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. J Acquir Immune Defic Syndr 2009; 51 349–55.
| Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS.Crossref | GoogleScholarGoogle Scholar | 19387357PubMed |
[53] Meng X, Zou H, Fan S, Zheng B, Zhang L, Dai X, et al Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data. AIDS Behav 2015; 19 882–9.
| Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data.Crossref | GoogleScholarGoogle Scholar | 25319954PubMed |
[54] Cheng W, Tang W, Zhong F, Babu GR, Han Z, Qin F, et al Consistently high unprotected anal intercourse (UAI) and factors correlated with UAI among men who have sex with men: implication of a serial cross-sectional study in Guangzhou, China. BMC Infect Dis 2014; 14 696
| Consistently high unprotected anal intercourse (UAI) and factors correlated with UAI among men who have sex with men: implication of a serial cross-sectional study in Guangzhou, China.Crossref | GoogleScholarGoogle Scholar | 25519034PubMed |
[55] Wu J, Hu Y, Jia Y, Su Y, Cui H, Liu H, et al Prevalence of unprotected anal intercourse among men who have sex with men in China: an updated meta-analysis. PLoS One 2014; 9 e98366
| Prevalence of unprotected anal intercourse among men who have sex with men in China: an updated meta-analysis.Crossref | GoogleScholarGoogle Scholar | 24874882PubMed |
[56] Chen JJ, Liu J, Li Y, Wang YY, Ma B, Gu LP, et al An analysis of the epidemic trend of HIV/ AIDS and the influencing factors among MSM in Lanzhou. Chin JAIDS & STD 2011; 17 328–31.
| An analysis of the epidemic trend of HIV/ AIDS and the influencing factors among MSM in Lanzhou.Crossref | GoogleScholarGoogle Scholar |
[57] Lieb S, White S, Grigg BL, Thompson DR, Liberti TM, Fallon SJ. Estimated HIV incidence, prevalence, and mortality rates among racial/ethnic populations of men who have sex with men, Florida. J Acquir Immune Defic Syndr 2010; 54 398–405.
| Estimated HIV incidence, prevalence, and mortality rates among racial/ethnic populations of men who have sex with men, Florida.Crossref | GoogleScholarGoogle Scholar | 20182358PubMed |
[58] Pachankis JE, Hatzenbuehler ML, Hickson F, Weatherburn P, Berg RC, Marcus U, et al Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS 2015; 29 1239–46.
| Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey.Crossref | GoogleScholarGoogle Scholar | 26035323PubMed |
[59] Dukers NH, Fennema HS, van der Snoek EM, Krol A, Geskus RB, Pospiech M, et al HIV incidence and HIV testing behavior in men who have sex with men: using three incidence sources, The Netherlands, 1984–2005. AIDS 2007; 21 491–9.
| HIV incidence and HIV testing behavior in men who have sex with men: using three incidence sources, The Netherlands, 1984–2005.Crossref | GoogleScholarGoogle Scholar | 17301568PubMed |
[60] Liu JX, Choi K. Experiences of social discrimination among men who have sex with men in Shanghai, China. AIDS Behav 2006; 10 25–33.
| Experiences of social discrimination among men who have sex with men in Shanghai, China.Crossref | GoogleScholarGoogle Scholar |
[61] Zhao Y, Ma Y, Chen R, Li F, Qin X, Hu Z. Non-disclosure of sexual orientation to parents associated with sexual risk behaviors among gay and bisexual MSM in China. AIDS Behav 2015; 20 193–203.
| Non-disclosure of sexual orientation to parents associated with sexual risk behaviors among gay and bisexual MSM in China.Crossref | GoogleScholarGoogle Scholar |
[62] Yun K, Xu JJ, Reilly KH, Zhang J, Jiang YJ, Wang N, et al Prevalence of bisexual behaviour among bridge population of men who have sex with men in China: a meta-analysis of observational studies. Sex Transm Infect 2011; 87 563–70.
| Prevalence of bisexual behaviour among bridge population of men who have sex with men in China: a meta-analysis of observational studies.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38%2FhsF2gtA%3D%3D&md5=3a43f3df758b484f3422dddb3f294f90CAS | 21954278PubMed |
[63] Wang HY, Xu JJ, Zou HC, Reilly KH, Zhang CM, Yun K, et al Sexual risk behaviors and HIV infection among men who have sex with men and women in China: evidence from a systematic review and meta-analysis. BioMed Res Intern 2015; 2015 850132
[64] Gao L, Zhang L, Jin Q. Meta-analysis: prevalence of HIV infection and syphilis among MSM in China. Sex Transm Infect 2009; 85 354–8.
| Meta-analysis: prevalence of HIV infection and syphilis among MSM in China.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MnjvFKjtA%3D%3D&md5=b9103b680c153d8eeb8f4184f837cd58CAS | 19351623PubMed |
