title: Risk Factors of HIV and Other Sexually Transmitted Infections in China: A Systematic Review of Reviews.
abstract: BACKGROUND
  Sexually Transmitted Infections (STIs) are a global challenge. China, once said to have eradicated STIs, is now facing a rapid rise in the prevalence of HIV/STIs. This review of reviews aims to map HIV/STI risk factors among the Chinese population, with the objective of identifying risk factors to inform the formulation of effective prevention strategies.
  
  
  METHODS
  A systematic search using key terms related to HIV/STIs, risk factors and the Chinese population in both English and Chinese databases (PubMed, PsycINFO, the Cochrane Library; Wanfang data, CNKI, VIP and SINOMED) was conducted, and peer-reviewed systematic reviews on the topic from 1991 to 2014 were selected. Identified risk factors were grouped into different level determinants based on the HIV Social Epidemiology Model, and then evaluated and reported based on the PRISMA checklist.
  
  
  RESULTS
  Of the twenty-eight reviews included, the majority were focused on well-established, individual level risk factors within key populations, with some highlighting the complexity of interacting factors (e.g., alcohol use and higher income in male migrants). While twenty-two reviews covered individual factors, only ten mentioned social factors and five had contents on structural factors. There are gaps in the evidence on social and structural level impacts of HIV/STIs, such as on stigma, discrimination, health policy, access to care, and illicit drug control policies. Migration and social expectation appear to pose a significant threat in aggravating the HIV/STI situation in China; for example, incarceration patterns indicated a significant risk of HIV/STIs for female sex workers.
  
  
  CONCLUSIONS
  Since international guidelines recommend an integrated and multi-level approach to HIV/STI prevention, a comprehensive approach targeting interventions at all levels along the continuum of care is needed to effectively curtail HIV/STI transmission in China. More research is needed to better understand the impact of socio-political interventions within a Chinese context.
authors.affiliation: Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
authors.forename: Tongyong
authors.initials: T
authors.lastname: Luo
authors.affiliation: University of North Carolina Project-China, Guangzhou, Guangdong Province, China; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.affiliation: Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China.
authors.forename: William Chi Wai
authors.initials: WC
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D002681:China; D055030:Drug Users / Q000706:statistics & numerical data; D006069:Gonorrhea / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D013587:Syphilis / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data; D000078202:Systematic Reviews as Topic