Prevalence and predictors of HIV infection among female sex workers in Kaiyuan City, Yunnan Province, China.

Background: Rural-to-urban migrants represent 17% of the total Chinese population and are considered a potential high-risk bridging population of HIV infection between urban and rural China. Method: Based on a systematic review and meta-analysis, this study determined HIV prevalence among rural-to-urban migrants in different stages of migration. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: We identified 54 studies reporting 59 HIV prevalence levels among rural-to-urban migrants in China. Overall, 53.4% (95% confidence interval, 33.5%-72.4%) of urban patients with HIV have migratory background. The floating-out population showed a higher HIV prevalence (0.15% [0.06%-0.34%]) than did the Chinese population (0.057%; odds ratio, 2.63 [1.35-5.14]). The floating-in population showed a higher HIV prevalence (0.38% [0.29%-0.50%]), corresponding to 6.70 (6.05-7.41) times greater odds of HIV infection. Higher prevalence levels were observed among female migrants (0.69% [0.51%-0.93%]), reflecting a much higher odds of HIV infection (12.18 [11.11-13.35]). Infection risk among returning migrants (0.18% [0.12%-0.29%]) was 3.16 (2.06-4.84) times higher than the overall Chinese population. Chinese internal migrants contribute to a substantial amount of the overall HIV epidemic in China. Conclusion: Migrants are at greater risk for HIV infection than the general Chinese population and likely to facilitate the geographical spread of HIV in China. Targeted strategies for health promotion and HIV prevention for migrants in China should be developed.

High HIV prevalence and risk of infection among rural-to-urban migrants in various migration stages in China: a systematic review and meta-analysis.

HIV stigma is rooted in culture and, therefore, it is essential to investigate it within the context of culture. The objective of this study was to examine the interrelationships among individualism-collectivism, HIV stigma, and social network support. A social network study was conducted among 118 people living with HIVAIDS in China, who were infected by commercial plasma donation, a nonstigmatized behavior. The Individualism-Collectivism Interpersonal Assessment Inventory (ICIAI) was used to measure cultural norms and values in the context of three social groups, family members, friends, and neighbors. Path analyses revealed (1) a higher level of family ICIAI was significantly associated with a higher level of HIV self-stigma (β=0.32); (2) a higher level of friend ICIAI was associated with a lower level of self-stigma (β=-035); (3) neighbor ICIAI was associated with public stigma (β=-0.61); (4) self-stigman was associated with social support from neighbors (β=-0.27); and (5) public stigma was associated with social support from neighbors (β=-0.24). This study documents that HIV stigma may mediate the relationship between collectivist culture and social network support, providing an empirical basis for interventions to include aspects of culture into HIV intervention strategies.

Collectivism Culture, HIV Stigma and Social Network Support in Anhui, China: A Path Analytic Model

Background
Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics.

/pdf/transitions-from-injection-drug-use-concentrated-to-self-5abkya3wqp.pdf

Transitions from Injection-Drug-Use-Concentrated to Self-Sustaining Heterosexual HIV Epidemics: Patterns in the International Data

Objectives: To identify key factors affecting condom use among male sex workers (MSW) who serve men in China. Method: In-depth semi-structured face-to-face interviews in Beijing and Shanghai, China. Informants were recruited through referral from a non-governmental organisation with a strong men who have sex with men (MSM) network and the snowball technique. Results: Between 2004 and 2005, 30 MSW were interviewed (Beijing n = 14; Shanghai n = 16). The MSW in this study were mainly single, young, homosexual, rural migrants with secondary education. None practised safer sex in their home towns. Until they migrated to big cities and entered the sex industry, they did not develop safer sex practices. They reported high condom use at work, but more than half of them (n = 17) had not been tested for HIV. Four factors, derived from the interviews and correlated to their rural background, sexual orientation and sex work identity, put MSW at risk of HIV/sexually transmitted infections (STI): incorrect AIDS knowledge; economic hardship; homosexual orientation and over-trusting in sexual relationships. Conclusion: MSW, a distinctive but often neglected group in both studies and sentinel surveillance among the MSM population in China, deserve special attention. There is not only potential for HIV/STI infection among the MSM population but also for infecting the general public. Education and prevention programmes should take their three major interlocking identities: rural migrant, sex worker and homosexual into consideration in social, cultural and economic contexts in China.

https://sti.bmj.com/content/sextrans/84/6/444.full.pdf

Risk factors affecting condom use among male sex workers who serve men in China: a qualitative study

China is currently experiencing one of the most rapidly expanding HIV epidemics in the world. Although the overall prevalence rate is still low, with a population of 1.3 billion, high-risk factors which have contributed to the HIV/AIDS epidemics worldwide continue to prevail in China, including a high rate of injecting drug use and needle sharing, commercial sex with low rates of condom use, and concurrent sex with both commercial sex workers and non-commercial casual or steady sex partners. In addition, there are increasing "double risk" populations overlapping drug users and sex workers, as well as increasing rates of STDs and HIV among high-risk populations. Sexual transmission, therefore, may serve as a bridge connecting high-risk populations with general populations. There is an urgent need to prevent the spread of HIV from these high-risk populations into the general population of China.

High risk populations and HIV-1 infection in China.

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High risk populations and HIV-1 infection in China.