A systematic review of interventions for men who have sex with men (MSM) in China: in need of theory-driven, community-based, and sustainable HIV prevention
A. Liau1, H. Yi2, J. Lau3, J. Gu4
1China Center for Disease Control and Prevention, National Center for AIDS/STD Control and Prevention, Beijing, China, 2Columbia University and New York State Psychiatric Institute, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York, United States, 3The Chinese University of Hong Kong, School of Public Health, Centre for Epidemiology & Biostatistics, Shatin, Hong Kong, 4Sun Yat-sen University, School of Public Health, Guangzhou, China
Background: Recent years have seen growing research interest in men having sex with men (MSM) in China due to rising HIV infection rates and risk behaviors in this population. Compared to reviews on the prevalence of HIV risk behavior and infection among MSM, interventions provided to this population have so far not been reviewed.
Methods: We conducted a systematic literature search on both English and Chinese databases, using keywords “HIV or HIV/AIDS”, “MSM”, “China”, and “intervention”. Mainland China-based interventions were included if they quantitatively evaluated knowledge, attitudes, skills or risk behaviors related to reducing HIV transmission. The following data were extracted from each study: sample characteristics; intervention components; outcome measures; and results of the evaluation.
Results: A total of twelve independent studies met the inclusion criteria. Eleven of them were located in Chinese-language journals. Ten studies evaluated MSM at the provincial level; the other two assessed MSM throughout China. Nine were single group studies; one had 2 arms, and the other had 3 arms. Snowball and venue-based sampling were the most common ways to recruit participants. Eight studies assessed both knowledge and risk behaviors; five studies assessed both attitudes towards AIDS and risk behaviors; and two studies assessed both condom use skills and risk behaviors. All studies indicated significant improvements in knowledge, attitudes and condom use skills to reduce HIV transmission among the intervention groups of 2-6 months recall periods.
Conclusions: Although the interventions reviewed suggest a positive short-term effect in MSM’s safer sex behaviors, there needs to be more rigorous research designs to increase population- and community-level impacts. Intervention approaches should be theoretically-driven and evidence-based so that the findings can be adapted and scaled up for various populations. Future interventions should also be tailor-made for high-risk subgroups of MSM to address relevant socio-cultural aspects of HIV prevention.