Heterosexual risk of HIV infection in China: systematic review and meta-analysis.

BACKGROUND: Heterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples. METHODS: A systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), and Medline databases. Pooled transmission estimates per 100 person-years (PY) were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy (ART) availability were conducted to assess the factors associated with transmission. RESULTS: Eleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 (95%CI 0.74 - 2.62) per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 (95%CI 0.09 - 2.14) per 100 PY and male-to-female transmission estimate was 1.43 (95%CI 0.19 - 2.68) per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program (2.13 (95%CI 0.00 - 4.63) per 100 PY) was higher than that for those after the implementation of this program (1.44 (95%CI 0.62 - 2.26) per 100 PY). CONCLUSIONS: Transmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.

[Study on the feasibility and related factors on semen samples from condoms, collected from sexual partners of and by the female sex workers for HIV-antibody testing].

OBJECTIVE: To explore the feasibility and related factors of using semen samples from condoms collected by their female sex workers (FSWs) for HIV-antibody testing. METHODS: FSWs were recruited by outreach workers. Semen samples from condoms of their sexual partners (paid or regular) were collected by FSWs themselves after intercourse and for HIV testing. Male partners were asked to participate in the study. Questionnaires were administered for both FSWs and heir male sexual partners. Blood samples were also collected for HIV testing. RESULTS: In total, 54 FSWs with 43 of their regular sexual partners and 57 casual clients were recruited. HIV prevalence, determined from serum samples, were 33.33% among FSWs, 29.82% and 23.26% among their clients and regular sexual partners. 40.35% and 30.23% of the semen samples from the condoms they used, were tested positive for HIV among clients and regular sexual partners of the FSWs. The sensitivity of semen samples from condoms for HIV-antibodies was 100% among both clients and regular sexual partners of the FSWs, while the rates of specificity were 85.00% and 90.91% respectively. Data from Univariate analysis indicated that among FSWs, factors as the characteristics of self-reported needle sharing and the male sexual partners who had one child, were associated with the disparity between serum and condom semen sample for HIV-antibody testing. CONCLUSION: HIV prevalence in male clients and regular sexual partners of the FSWs might be overestimated according to the HIV-antibody testing results of semen samples from condoms collected by FSWs themselves. Lower specificity indicated that FSWs with positive HIV might have contaminated the semen samples from the condom used by their HIV negative sexual partners.