title: Effectiveness of HIV risk reduction interventions among men who have sex with men in China: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the effect of risk reduction interventions on HIV knowledge, attitudes and behaviors among men who have sex with men (MSM) in China.
  
  
  METHODS
  We performed a systematic review and meta-analysis of HIV risk reduction intervention studies among Chinese MSM. The summary difference of standardized mean differences (SMD) between both study arms or between pre- and post-intervention assessments were defined as the effect size (ES); ES was calculated using standard meta-analysis in random effects models.
  
  
  RESULTS
  Thirty-four eligible studies were included in the analysis, including two randomized clinical trials (RCT), six quasi-experimental studies, six pre-and-post intervention studies, and twenty serial cross-sectional intervention studies. These studies showed an increase in consistent condom use with any male sexual partners (mean ES, 0.46; 95% confidence interval [CI], 0.35-0.56), with regular sexual partners (mean ES, 0.41; 95% CI, 0.18-0.63), and casual sexual partners (mean ES, 0.52; 95% CI, 0.24-0.79). The analysis of ten studies that measured the impact on uptake of HIV testing also showed a positive result (mean ES, 0.55; 95% CI, 0.38-0.71). The risk reduction interventions also improved HIV/AIDS-related knowledge (mean ES, 0.77; 95% CI, 0.60-0.94) and attitudes (mean ES, 1.35; 95% CI, 0.91-1.79), but did not reduce prevalence of HIV (mean ES, 0.23; 95% CI, 0.02-0.45) and syphilis infections (mean ES, -0.01; 95% CI, -0.19-0.17). There was significant heterogeneity among these studies.
  
  
  CONCLUSIONS
  On aggregate, HIV risk reduction interventions were effective in reducing risky behaviors and improving knowledge and attitudes among Chinese MSM, but were not associated with a change in the prevalence of HIV and syphilis. Future studies should use incidence as definitive study outcome.
authors.affiliation: Institute for AIDS/STD Prevention & Control, Beijing Center for Disease Prevention and Control, Beijing, China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Lu
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.forename: Kapil
authors.initials: K
authors.lastname: Dahiya
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
authors.forename: Wensheng
authors.initials: W
authors.lastname: Fan
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Juntao
authors.initials: J
authors.lastname: Ma
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
mesh_terms: D002681:China / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000706:statistics & numerical data*; D013587:Syphilis / Q000453:epidemiology / Q000517:prevention & control