Yun and colleagues aimed to integrate empirical estimates of bisexual behaviour among the bridge population of men who have sex with men in China and their HIV and syphilis prevalences stratified by sexual behaviour. Pubmed, Chinese Biomedical, Chinese National Knowledge Infrastructure, VIP, Wanfang and Google Scholar databases were searched to January 2011 to identify relevant articles. Data for eligible citations were extracted by two reviewers. All analyses were performed using Stata 10.0. Forty-nine articles (including 28?739 study subjects who were men who had sex with men) met the selection criteria. Aggregated findings indicated that the estimated prevalence of bisexual behaviour among men who have sex with men in China is 31.2% (95% CI 28.1% to 34.5%). HIV and syphilis prevalences were 5.4% and 11.4%, respectively, among men who have sex with men engaging in bisexual behaviour and 3.8% and 9.3% among those who were only having sex with men. HIV prevalence among men who have sex with men engaging in sex with both men and women was significantly higher than in those who were only having sex with men (OR 1.30; 95% CI 1.04 to 1.62; p=0.02). There is a high prevalence of bisexual behaviour among men who have sex with men in China and bisexual behaviour is significantly associated with increased HIV infection risk. The results of this meta-analysis highlight a critical pattern of HIV transmission among men who have sex with men in China and indicate that targeted interventions aimed at encouraging safe sex practices and promoting societal and family acceptance of men who have sex with men are urgently needed.
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