International Journal of Infectious Diseases (Oct 2015)

A systematic review and meta-analysis of the prevalence, trends, and geographical distribution of HIV among Chinese female sex workers (2000–2011): implications for preventing sexually transmitted HIV

  • Lei Zhang,
  • Eric P.F. Chow,
  • Shu Su,
  • Wai Lok Yiu,
  • Xiaohu Zhang,
  • Ka I. Iu,
  • Keith Tung,
  • Rui Zhao,
  • Peng Sun,
  • Xiaoshu Sun,
  • Lei Yuan,
  • Kathryn E. Muessig,
  • Joseph D. Tucker,
  • Jun Jing

DOI
https://doi.org/10.1016/j.ijid.2015.08.014
Journal volume & issue
Vol. 39, no. C
pp. 76 – 86

Abstract

Read online

Objective: 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. Methods: 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. Results: The national HIV prevalence among FSWs declined from 0.74% (95% confidence interval (CI) 0.37–1.49%) in 2000–2002 to 0.40% (95% CI 0.31–0.53%) 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% (95% CI 0.86–4.24%) to 0.87% (95% CI 0.65–1.18%) during 2000–2011, Southwest China still bore the greatest HIV disease burden. Nationwide, FSWs recruited from detention centres had the highest HIV prevalence (0.92%, 95% CI 0.46–1.88%), followed by voluntary counselling and testing sites (0.80%, 95% CI 0.46–1.67%) and entertainment venues (0.61%, 95% CI 0.47–0.79%). The prevalences among FSWs in high-, middle-, and low-tier entertainment venues were 0.59% (95% CI 0.32–1.45%), 0.92% (95% CI 0.50–1.77%), and 1.10% (95% CI 0.71–2.16%), 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). Conclusions: 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.

Keywords