Sexually Transmitted Infections (STIs) are a global
challenge. China, once said to have eradicated STIs, is now facing a rapid rise
in the prevalence of HIV/STIs. This review of reviews aims to map HIV/STI risk
factors among the Chinese population, with the objective of identifying risk
factors to inform the formulation of effective prevention strategies.
A systematic search using key terms related to HIV/STIs,
risk factors and the Chinese population in both English and Chinese databases
(PubMed, PsycINFO, the Cochrane Library; Wanfang data, CNKI, VIP and SINOMED)
was conducted, and peer-reviewed systematic reviews on the topic from 1991 to
2014 were selected. Identified risk factors were grouped into different level
determinants based on the HIV Social Epidemiology Model, and then evaluated and
reported based on the PRISMA checklist.
Of the twenty-eight reviews included, the majority were focused
on well-established, individual level risk factors within key populations, with
some highlighting the complexity of interacting factors (e.g., alcohol use and
higher income in male migrants). While twenty-two reviews covered individual
factors, only ten mentioned social factors and five had contents on structural
factors. There are gaps in the evidence on social and structural level impacts
of HIV/STIs, such as on stigma, discrimination, health policy, access to care,
and illicit drug control policies. Migration and social expectation appear to
pose a significant threat in aggravating the HIV/STI situation in China; for
example, incarceration patterns indicated a significant risk of HIV/STIs for
female sex workers.
Since international guidelines recommend an integrated and
multi-level approach to HIV/STI prevention, a comprehensive approach targeting
interventions at all levels along the continuum of care is needed to
effectively curtail HIV/STI transmission in China. More research is needed to
better understand the impact of socio-political interventions within a Chinese
context...
Our review identified that among the structural
risks, the incarceration pattern reveals a significant risk of HIV/STIs for
FSW. Internationally, it is found that compared with the general public, the
prevalence of HIV/STIs in the prison population is two-to-ten times higher, due
to prevalence of unprotected sexual intercourse and intravenous drug use [64]. The objective of the re-education of sex
workers, according to the Chinese policy, is to guide FSW away from “bad
habits” [60]. However, evidence suggests the
re-education policies are exposing FSW to increased risk of HIV/STIs, thus,
there is need to re-consider the current policies [65]. Further,
modelling suggests that decriminalization of sex workers could avert up to
33%-46% of HIV infections [66]. In China, more
than 40 scholars and lawyers advocated for abolishment of detention education
to the National People's Congress and the Chinese Political Consultative
Conference in 2014 [67].
...It has been
identified that condom-less anal intercourse, multiple partners, migration and
sex work were all found to pose significant risks for HIV infection among MSM.
HIV prevention needs to take into consideration context-specific strategies.
Engaging in sex with both male and female partners was associated with 30%
increase in HIV infection, which presents a particular challenge in China given
that at least one-third of Chinese MSM have wives or female partners to fulfil
social expectations and pressures to marry and have children [27, 70]. In addition, a
recent review found that although behavioural interventions alone can increase
consistent condom use, it had little impact on HIV or syphilis infection [71], suggesting a
need to incorporate behavioural, biomedical, social and structural dimensions [62]...
By:
1Department of Family Medicine and Primary
Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
S.A.R., China
2The Jockey Club School of Public Health
and Primary Care, The Chinese University of Hong Kong, Hong Kong S.A.R., China
3University of North Carolina
Project-China, Guangzhou, Guangdong Province, China
4London School of Hygiene and Tropical
Medicine, London, United Kingdom
Centers for
Disease Control and Prevention, UNITED STATES
#Contributed equally.
Competing Interests: The authors have declared
that no competing interests exist.
Conceived and designed the experiments: WCWW YZ. Performed
the experiments: YZ TL. Analyzed the data: YZ WCWW TL JDT. Contributed
reagents/materials/analysis tools: WCWW YZ TL JDT. Wrote the paper: YZ TL WCWW
JDT.
* E-mail: kh.ukh@wcwgnow
More at: https://twitter.com/hiv_insight
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