title: A systematic review and meta-analysis of the prevalence, trends, and geographical distribution of HIV among Chinese female sex workers (2000-2011): implications for preventing sexually transmitted HIV.
abstract: OBJECTIVE
  The aim of this meta-analysis was to investigate temporal and geographical trends in the HIV epidemic among female sex workers (FSWs) recruited from various venues in China.
  
  
  METHODS
  Chinese and English peer-reviewed articles published between January 2000 and February 2013 were systematically searched. Standard meta-analysis methods were used to calculate the pooled HIV prevalence, in accordance with the PRISMA guidelines.
  
  
  RESULTS
  The national HIV prevalence among FSWs declined from 0.74% (95% confidence interval (CI) 0.37-1.49%) in 2000-2002 to 0.40% (95% CI 0.31-0.53%) in 2009-2011. All Chinese regions demonstrated significant declines in HIV prevalence, apart from the East and South Central regions, in which the epidemics stabilized at low/moderate levels. Despite a significant decline from 1.92% (95% CI 0.86-4.24%) to 0.87% (95% CI 0.65-1.18%) during 2000-2011, Southwest China still bore the greatest HIV disease burden. Nationwide, FSWs recruited from detention centres had the highest HIV prevalence (0.92%, 95% CI 0.46-1.88%), followed by voluntary counselling and testing sites (0.80%, 95% CI 0.46-1.67%) and entertainment venues (0.61%, 95% CI 0.47-0.79%). The prevalences among FSWs in high-, middle-, and low-tier entertainment venues were 0.59% (95% CI 0.32-1.45%), 0.92% (95% CI 0.50-1.77%), and 1.10% (95% CI 0.71-2.16%), respectively. High- and middle-tier FSWs had a significantly lower risk of HIV infection than lower-tier FSWs (high/low: odds ratio (OR) 0.48, 95% CI 0.40-0.59; middle/low: OR 0.49, 95% CI 0.37-0.66).
  
  
  CONCLUSIONS
  The HIV epidemic has shown a gradual declining or stabilizing trend among Chinese FSWs. Intervention efforts should be diverted to high-risk subgroups of FSWs, such as drug-using and low-tier FSWs.
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Eric P F
authors.initials: EP
authors.lastname: Chow
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Shu
authors.initials: S
authors.lastname: Su
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Wai Lok
authors.initials: WL
authors.lastname: Yiu
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
authors.forename: Xiaohu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ka I
authors.initials: KI
authors.lastname: Iu
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Keith
authors.initials: K
authors.lastname: Tung
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Sun
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
authors.forename: Xiaoshu
authors.initials: X
authors.lastname: Sun
authors.affiliation: The School of Sociology and Population Studies, Remin University of China, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yuan
authors.affiliation: The University of North Carolina Project-China, Guangzhou, China; Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Muessig
authors.affiliation: The University of North Carolina Project-China, Guangzhou, China; London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: jingjun@tsinghua.edu.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Jing
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D060386:Sex Workers; D055815:Young Adult
keywords: China; Epidemiology; Female sex workers; HIV; Risk behaviours