Sexually transmitted infections among heterosexual male clients of female sex workers in China: a systematic review and meta-analysis.
BACKGROUND
Female sex workers have been the target of numerous sexually transmitted infection (STI) prevention strategies in China, but their male clients have attracted considerably less public health attention and resources. We sought to systematically assess the prevalence of HIV, syphilis, gonorrhea, and chlamydia among heterosexual male clients of female sex workers in China.


RESULTS
Original research manuscripts were identified by searching Chinese and English language databases, and 37 studies analyzing 26,552 male clients were included in the review. Client STI prevalence across studies was heterogeneous. Pooled prevalence estimates and 95% confidence intervals were 0.68% (0.36-1.28%) for HIV, 2.91% (2.17-3.89%) for syphilis, 2.16% (1.46-3.17%) for gonorrhea, and 8.01% (4.94-12.72%) for chlamydia.


CONCLUSIONS
The pooled prevalence estimates of HIV, syphilis, gonorrhea, and chlamydia among clients in this review exceed the prevalences previously reported among population-representative samples and low-risk groups in China. However, heterogeneity across studies and sampling limitations prevent definitive conclusions about how the prevalence of STIs in this population compares to the general population. These findings suggest a need for greater attention to clients' sexual risk and disease prevalence in China's STI research agenda in order to inform effective prevention policies.
UNC Project - China, Guangzhou, China. mclaughlin.megan@gmail.com
Megan M
MM
McLaughlin
Eric P F
EP
Chow
Cheng
C
Wang
Li-Gang
LG
Yang
Bin
B
Yang
Jennifer Z
JZ
Huang
Yanjie
Y
Wang
Lei
L
Zhang
Joseph D
JD
Tucker
D002681:China / Q000453:epidemiology; D005260:Female; D020010:Heterosexuality; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control