Meta - Analysis Of HIV Infection And Positive Transmission Prevention Among Male Male Sex Workers In

BackgroundIn recent years, the HIV prevalence of men who have sex with men (MSM) was rising rapidly, among the reported cases, the proportion of transmitted by MSM increased from0.3%before2005to0.7%in2005, to3.5%in2007,10.0%in2009and15.0%in2011.HIV infected people who have been found, will increase awareness of HIV infection, after received test results and reducing high-risk behavior counseling. HIV-positive will receive the appropriate follow-up care, psychological support, referral and treatment services. Providing relevant knowledge and methods to the infected people to reduce high-risk behavior, preventing of transmission to other people, can reduce secondary transmission, to play the role of "HIV Positive Prevention (Positive prevention)", reducing the spread of HIV. Therefore, we conducted the research of MSM HIV infection and its influencing factors in Chongqing, and meta-analysis to assess the effects of preventive measures to control HIV-positive transmission, in order to provide scientific basis for developing targeted prevention and controlling of the HIV epidemic.Objective1. To assess the prevalence of men who have sex with men(MSM) in Chongqing during2009-2011and its potential impact factors.2. through the meta-analysis to know the effectiveness of HIV-positive prevention in reducing the risk behaviors of HIV-positive people and unprotected anal sex of HIV-positive MSMMethods1. MSM in Chongqing were recruited for surveys using respondent driven sampling (RDS) in2009,2010, and2011, separately. After finished a computer-assisted questionnaire on the spot, blood specimens were drawn for HIV and syphilis testing. SAS version9.1was used to conduct description Statistical analysis and logistic regression.2. Using the search terms(HIV-infected OR HIV infections OR HIV-positive OR HIV seropositive OR people living with HIV OR AIDS OR acquired immunodeficiency syndrome) AND (behavior therapy OR behavioral intervention OR risk reduction intervention OR clinical trial OR intervention study), systematicly search16electronic databases, AMED, British Library Direct, British Nursing Index, Centre for Reviews and Dissemination databases,Cochrane Library, EMBASE, EconLit, ERIC, Ovid Medline, PsycINFO, Scopus, Web of Science, and Global Health Library Virtual Platform, Wanfang data,CBM, CNKI. In addition, we conducted cross-referencing, searching risk reduction interventions guided by various theory. The interested outcomes were unprotected sex, number of sexual partners, drug use, needle sharing, and/or alcohol abuse. As the measurements were either expressed as proportion differences or as mean differences of frequency, we converted estimates to a common metric of standard mean differences (SMD). SMD in each study arm was calculated as the difference of mean at follow-up and baseline divided by the pooled standard deviation (SD) of these two means. When studies reported dichotomous outcomes, odds ratios were transformed into SMDs using Cox transformation. The difference of SMDs between study arms, defined as effect size (ES), was calculated for each study and then pooled across studies using standard meta-analysis with a random effects model. The meta-analysis results were displayed with forest plots. Heterogeneities were assessed by I2statistics, and standardized deleted residual analyses were performed to identify outliers. The funnel plot, Begg and Mazumdar rank correlation test and Egger’s test of the intercept were employed to assess indications of publication bias.Result1.510、482、391MSM were recruited in2009,2010, and2011respectively, the HIV prevalence rate was11.6%、15.4%、19.2%.70were BED-CEIA positive, the BED-CEIA incidence of HIV was7.9/100person-years (PY),12.0/100PY,18.1/100PY in2009,2010, and2011respectively. In multivariable analysis, MSM who completed college or more (OR=0.4,95%C1:0.3-0.5)were at decreased risk of HIV prevalence; MSM who had more than one male sex partners in the past6months (OR=1.7,95%CI:1.2-2.4), had unprotected anal sex in the past6months (OR=1.7,95%CI:1.2-2.4), had sexually transmitted disease symptoms in the past year (OR=1.8,95%CI:1.1-2.8), syphilis positive(OR=5.6,95%CI:3.3-9.6), surveyed in2011(OR=2.8,95%CI:1.9-4.3)were at increased risk of HIV prevalence. MSM who completed college or more(OR=0.5,95%CI:0.3-0.9)were at decreased risk of BED-CEIA incidence; MSM who had more than one male sex partners in the past6months (OR=2.4,95%CI:1.4-4.2), had unprotected anal sex in the past6months (OR=2.0,95%CI:1.2-3.5), had sexually transmitted disease symptoms in the past year(OR=2.0,95%CI.1.0-4.0), syphilis positive(OR=4.5,95%CI:1.8-11.0), surveyed in2011(OR=4.3,95%CI:2.2-8.3)were at increased risk of BED-CEIA incidence.2. Meta-analysis showed that the reduction of unprotected sex with any partner of intervention group was statistically significant (CES:-0.22;95%CI:-0.32,-0.11) compared with control group. The reduction of unprotected sex within10months was statistically significance (1-5months:-0.27,95%CI:-0.45,-0.10);6-10months:-0.18,95%CI:-0.30,-0.07), while no significant showed in long-term effects of intervention (11-15months:-0.13,95%CI:-0.34,0.08);(>15months:-0.05,95%CI:-0.43,0.32). The reduction of unprotected sex with HIV-negative or HIV status unknown partner of intervention group was statistically significant (CES:-0.13;95%CI:-0.22,-0.04) compared with control group. The reduction of total number of sexual partners of the intervention group was not statistically significant (CES:-0.10;95%CI:-0.26,0.06), The reduction of HIV-negative or unknown HIV status partners was not statistically significant (CES:0.003;95%CI:-0.54,0.54). The reduction of drug use of the intervention group of HIV-positive drug users was statistically significant (CES:-0.26;95%CI:-0.51,-0.01), but the effect is mainly contributed to one study. The reduction of needle sharing (CES:-0.15;95%CI:-0.43,0.13) and alcohol reduction (CES:-0.10;95%CI:-0.36,0.17) of the intervention group Intervention group were not statistically significant. Neither heterogeneity nor publication bias was found. There were5literatures’subjects were more than a half MSM, Meta-analysis found that the reduction of unprotected sex among these people with any partner was statistically significant (CES:-0.25;95%CI:-0.39,-0.10). The reduction of unprotected anal sex of HIV infected MSM with HIV-negative or unknown partners was not statistically significant (CES:-0.11;95%CI:-0.28,0.06). Neither heterogeneity nor publication bias was found.Conclusions1. The HIV prevalence and BED-CEIA incidence were high, and rises rapidly. The risk reduction intervention among MSM should focus on who completed high school or less, had more than one male sex partners, had unprotected anal sex, had sexually transmitted disease or syphilis positive, to control rapid spread of HIV among MSM and common people.2. The short-term impact of prevention interventions on reducing self-reported UVAI among PLWHA irrespective of the type of sexual partner was showed, but did not show long-term effect. Positive intervention should be included in the project of risk reduction, in order to reduce HIV-positive population unprotected sex with good results, the future risk reduction interventions, to explore long-term effective intervention programs is necessary. Group-based interventions were more effective-than individual-based intervention. Behavioral interventions was effective in reducing unprotected sex with HIV-negative or status unknown partners. No intervention effect was shown in reducing the number of sexual partners, drugs use, needle sharing, alcohol abuse among HIV-positive people effect. It is recommended that we taken long-term effective intervention to reduce unprotected sex among PLWHA in future risk reduction programs. No reduction by behavioral intervention was showed among HIV-positive people of the number of sexual partners of, drug use, needle sharing, alcoholism. The reduction of unprotected anal sex of HIV-positive MSM with HIV-negative or HIV status unknown partner has not been confirmed, pending on further study.