title: High prevalence of HIV infection and unprotected anal intercourse among older men who have sex with men in China: a systematic review and meta-analysis.
abstract: BACKGROUND
  China has the largest number of the elderly in the world. As the proportion of elderly is rapidly increasing among national reported HIV/AIDS cases, it is a concern about HIV epidemic among older MSM in China. However, studies on HIV prevalence and unprotected anal intercourse (UAI) among Chinese older MSM were relatively few or generally had small sample sizes.
  
  
  METHODS
  English and Chinese articles published in peer-reviewed journals were identified by systematically searching 5 electronic databases including PubMed and through cross-referencing. Summary prevalence rates of HIV infection and UAI with male sexual partners were calculated, and analyses were performed using the software Comprehensive Meta-Analysis V2.0 and SPSS V17.0. Subgroup analyses were performed separately by sample size, study year, study location, recruitment settings and sampling method.
  
  
  RESULTS
  Twenty eligible cross-sectional studies (3 in English and 17 in Chinese), published between 2005 and 2013, with a total of 2812 older MSM participants, were identified. Our meta-analyses showed that the prevalence of HIV, syphilis and UAI in the last 6 months were 11.6% (95% confidence interval [CI]: 8.0%-16.6%), 23.0% (95% CI: 15.8%-32.3%) and 79.5% (95% CI: 72.7%-84.9%), respectively. HIV prevalence increased over the study period (6.3% in 2003-2007; 8.6% in 2008-2009, and 11.5% in 2010-2011, trend test Chi-square = 7.02, p = 0.008). The pooled prevalence of HIV (11.6% vs. 5.2%, Chi-square value = 36.2, p < 0.001) and UAI (79.5% vs. 52.6%, Chi-square value = 440.04, p < 0.001) among older MSM were both significantly higher than among younger age group (age < 50 years).
  
  
  CONCLUSIONS
  Older Chinese MSM have high prevalence of HIV and syphilis. Unprotected anal sex is common and further puts them at high risks of acquiring and transmitting HIV, which was one of reasons for the rapid increasing of national reported older male HIV/AIDS cases. Prevention intervention programs should be specially tailored for this high risk MSM subgroup.
authors.forename: Yong-ze
authors.initials: YZ
authors.lastname: Li
authors.forename: Jun-jie
authors.initials: JJ
authors.lastname: Xu
authors.forename: Han-zhu
authors.initials: HZ
authors.lastname: Qian
authors.forename: Bing-xin
authors.initials: BX
authors.lastname: You
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.forename: Jian-ming
authors.initials: JM
authors.lastname: Zhang
authors.forename: Qing-hai
authors.initials: QH
authors.lastname: Hu
authors.forename: Zhen-xing
authors.initials: ZX
authors.lastname: Chu
authors.forename: Shu-yang
authors.initials: SY
authors.lastname: Liu
authors.forename: Yong-jun
authors.initials: YJ
authors.lastname: Jiang
authors.forename: Wen-qing
authors.initials: WQ
authors.lastname: Geng
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China. hongshang100@hotmail.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Shang
mesh_terms: D017677:Age Distribution; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D012725:Sexual Behavior / Q000706:statistics & numerical data; D013587:Syphilis / Q000453:epidemiology / Q000635:transmission; D047568:Unsafe Sex / Q000706:statistics & numerical data*