A Systematic Review & Meta-Analysis of the Prevalence, Trends & Geographical Distribution of HIV among Chinese Female Sex Workers (2000-2011): Implications for Preventing Sexually Transmitted HIV

The aim of this meta-analysis was to investigate temporal and geographical trends in the HIV epidemic among female sex workers (FSWs) recruited from various venues in China.

Chinese and English peer-reviewed articles published between January 2000 and February 2013 were systematically searched. Standard meta-analysis methods were used to calculate the pooled HIV prevalence, in accordance with the PRISMA guidelines.

• The national HIV prevalence among FSWs declined from 0.74% in 2000-2002 to 0.40% in 2009-2011. 
• All Chinese regions demonstrated significant declines in HIV prevalence, apart from the East and South Central regions, in which the epidemics stabilized at low/moderate levels. 
• Despite a significant decline from 1.92% to 0.87% during 2000-2011, Southwest China still bore the greatest HIV disease burden. 
• Nationwide, FSWs recruited from detention centres had the highest HIV prevalence, followed by voluntary counselling and testing sites and entertainment venues. 
• The prevalences among FSWs in high-, middle-, and low-tier entertainment venues were 0.59%, 0.92%, and 1.10%, respectively. 
• High- and middle-tier FSWs had a significantly lower risk of HIV infection than lower-tier FSWs (high/low: odds ratio (OR) 0.48, 95% CI 0.40-0.59; middle/low: OR 0.49, 95% CI 0.37-0.66).

The HIV epidemic has shown a gradual declining or stabilizing trend among Chinese FSWs. Intervention efforts should be diverted to high-risk subgroups of FSWs, such as drug-using and low-tier FSWs.

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Below:  Estimated HIV prevalence among female sex workers across the six regions in China during 2000–2011

Below:  The six Chinese geographical regions. The number in each province represents the number of publications reporting HIV prevalence among female sex workers (n = 456). The number in brackets represents the total number of HIV prevalence estimates identified (n = 848).

By: Zhang L1, Chow EP1, Su S2, Yiu WL2, Zhang X3, Iu KI2, Tung K2, Zhao R3, Sun P3, Sun X3, Yuan L4, Muessig KE5, Tucker JD6, Jing J7.

• 1Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
• 2The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
• 3Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
• 4The School of Sociology and Population Studies, Remin University of China, Beijing, China.
• 5The University of North Carolina Project-China, Guangzhou, China; Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina, Chapel Hill, North Carolina, USA.
• 6The University of North Carolina Project-China, Guangzhou, China; London School of Hygiene and Tropical Medicine, London, UK.
• 7Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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