Abstract:Objective To systematically evaluate the incidence of high-risk sexual behaviors among human immunodeficiency virus (HIV) infected individuals in China, provide reference for developing targeted interventions to reduce HIV transmission and promote the health of this population. Methods Eight databases including CNKI, Wanfang Database, SinoMed, PubMed, Web of Science, Embase, the Cochrane Library and CINAHL were retrieved with key words of "AIDS", "high-risk sexual behavior", "HIV", and "unsafe sex". The references of included lite-ratures were also traced. Publication date was limited from January 1, 2017 to March 31, 2022. The pooled incidences and 95% confidence intervals of various types of high-risk sexual behaviors were calculated. Subgroup analysis on unprotected sexual behaviors was conducted, and differences among groups were inferred with χ2 test. Results A total of 22 Chinese literatures and 8 English literatures were included, with a total sample size of 19 764 individuals, covering 17 provinces (municipalities and autonomous regions) in China. Meta-analysis results showed that the incidences and 95% confidence intervals of various types of high-risk sexual behaviors among HIV-infected individuals in China were 39.7% (33.8%-45.5%) for unprotected sex, 43.3% (24.4%-62.2%) for multiple sexual partners, 27.2% (15.3%-39.1%) for casual sex, and 14.7% (9.1%-20.2%) for commercial sex. Based on the data, subgroup analysis on unprotected sex in this population revealed that the incidences of unprotec-ted sex among different subgroups, including different gender, age, education, marital status, type of sexual beha-vior, region, survey time, antiviral therapy, and infection status of regular sexual partners, were all significantly different (all P < 0.05). Conclusion The incidence of high-risk sexual behaviors among HIV-infected individuals is high. It is necessary to focus on the interventions to those with a high incidence of unprotected sex, including the middle-aged and elderly individuals and individuals without antiviral therapy. Meanwhile, the causes for regional differences should be explored to develop more targeted prevention strategies.