View at Google Scholar R. Given this challenge, we should develop specific prevention strategies targeting MSMW from the following three aspects. Moreover, MSMW more likely use illicit drugs in this study. All authors read and approved the final paper. View at Google Scholar E. As MSMW feared exposing their homosexual orientation to their female spouse or partner, some may choose to buy sex from MBs [ 59 ]. Quantitative Data Synthesis 3. View at Google Scholar W.
View at Google Scholar L. A sensitivity analysis was conducted by omitting each study one at a time to assess the influence of each study on the overall estimate. Conflict of Interests The authors declare that they have no conflict of interests. Acknowledgments The authors appreciate all the researchers whose articles were included in the study. Building on our earlier research, we integrated the latest extensive 31 additional published pieces of literature and further validated that Chinese MSMW have a significantly higher HIV prevalence than MSMO, which is similar to our previous conducted meta-analysis results [ 16 ]. Sensitivity Analysis and Publication Bias The pooled rates and ORs were not significantly affected in the sensitivity analysis, suggesting that the results were robust. View at Google Scholar K. Therefore, we performed subgroup analyses to explore the potential sources of between-study heterogeneity on 1 study region: View at Google Scholar Q. Flow diagram of studies included in analysis. The findings yielded in this study have some important implications for national HIV prevention and care planning and intervention development. Third, the majority of included articles of this study recruited participants in urban locations, so rural representation was limited. View at Google Scholar W. Second, we should take measure of MSMW on preventing high risk commercial sex and substance use; meanwhile, we should enhance their consciousness of protecting themselves as well as their partners both male and female. Given this challenge, we should develop specific prevention strategies targeting MSMW from the following three aspects. View at Google Scholar R. Quantitative Data Synthesis 3. If significant homogeneity was detected , , fixed effect models were employed to calculate the pooled effect rates and ORs; otherwise random effects models were employed [ 21 ]. This systematic review and meta-analysis has several important limitations. Fourth, for lack of data from Northwest and other areas in China, it is difficult to reflect the comprehensive national HIV epidemic. Additionally, it is essential to actively advocate for the respect and social equality of people with bisexual and homosexual orientations and reduce the social discrimination and family pressures for MSM. Moreover, MSMW more likely use illicit drugs in this study. As substance use may relax safer sex norms and increase unprotected anal sex, a higher substance use rate in MSMW may increase the risk of HIV transmission [ 63 — 65 ]. The first two authors contributed equally to this meta-analysis. Xu for reviewing the present paper and providing great guidance. Second, though we attempted to be as inclusive as possible, our available database searches may have excluded relevant studies from this systematic review and meta-analysis. All authors read and approved the final paper.
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