Heterosexual Transmission of HIV in China: A Systematic Review of Behavioral Studies in the Past Two Decades

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Abstract

The objective of this study was to address the role of heterosexual transmission of HIV in China. The goal of this study was to explore the prevalence of unsafe sex and the likelihood of HIV spread heterosexually from core populations to others. The authors conducted a review of behavioral studies. Drug users were more likely to be involved in higher-risk sexual behaviors than were those who abstained from using drugs. Most female drug users (52-98%) reported having engaged in commercial sex. Most female sex workers (FSWs) and individuals with sexually transmitted diseases (STDs) had concurrent sexual partners. Many continued to have unprotected sex after noticing STD symptoms in themselves or their sexual partners. From 5% to 26% of rural-to-urban migrants had multiple sexual partners and 10% of males patronized FSWs during migration. Factors such as high rates of FSW patronage, low rates of condom use during commercial sex, having sex with both commercial and noncommercial sexual partners, and high rates of STD infection may promote a heterosexual epidemic in China.

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Lynn Woodhouse, J J Potterat, Stephen Q. Muth … (1998)

To prospectively study changes in the social networks of persons at presumably high risk for HIV in a community with low prevalence and little endogenous transmission. From a cohort of 595 persons at high risk (prostitutes, injecting drug users, and sexual partners of these persons) and nearly 6000 identified contacts, we examined the social networks of a subset of 96 persons who were interviewed once per year for 3 years. We assessed their network configuration, network stability, and changes in risk configuration and risk behavior using epidemiologic and social network analysis, and visualization techniques. Some significant decrease in personal risk-taking was documented during the course of the study, particularly with regard to needle-sharing. The size and number of connected components (groups that are completely connected) declined. Microstructures (small subgroups of persons that interact intensely) were either not present, or declined appreciably during the period of observation. In this area of low prevalence, the lack of endogenous transmission of HIV may be related in part to the lack of a network structure that fosters active propagation, despite the continued presence of risky behaviors. Although the relative contribution of network structure and personal behavior cannot be ascertained from these data, the study suggests an important role for network configuration in the transmission dynamics of HIV.

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HIV/STD risk behaviors and perceptions among rural-to-urban migrants in China.

Xiaoming Li, Xiaoyi Fang, Danhua Lin … (2004)

Data from 2,153 sexually active rural-to-urban migrants in China were analyzed to examine the relationship between the movement of rural-to-urban migration and increased HIV/STD (sexually transmitted disease) risk and the applicability of constructs of a Western-based theory of behavioral change to the study population. Measurements included migrant mobility, sexual risk, and the seven constructs of the protection motivation theory (PMT). Data in the current study suggest that high mobility among rural-to-urban migrants was associated with increased sexual risk. The PMT constructs are applicable in identifying perceptions and attitudes associated with sexual risk behaviors in this culturally distinct population. Increased sexual risk was associated with increased perceptions of extrinsic rewards, intrinsic rewards, and response cost. Also consistent with PMT, increased sexual risk was associated with perceptions of decreased severity, vulnerability, response efficacy, and self-efficacy. After controlling for a number of key confounding factors, all seven PMT constructs were associated with sexual risk in the manner posited by the theory. The association between mobility and sexual risk underscores the importance of effective HIV/STD prevention efforts among this vulnerable population. The social cognitive theories including the PMT may form a logical base for prevention intervention programs targeting rural-to-urban migrants in China.

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Prevalence of HIV infection among former commercial plasma donors in rural eastern China.

R Detels, K M Rou, Zunyou Wu (2001)

Sporadic reports of HIV-1 infection among commercial plasma donors in China between 1994 and 1995. (1) To determine the prevalence of HIV infection among repeat plasma donors; (2) to identify factors associated with HIV infection; and (3) to describe characteristics associated with secondary transmission. Plasma/blood donors who had a history of donating plasma/blood before March 1, 1995, their spouses, and their children under 5 years were recruited for a cross-sectional study. A questionnaire and an HIV test were collected anonymously. Information collected included demographic characteristics, sexual behaviour, recreational drug use and history of medical care and blood/plasma donation. HIV antibody was identified by the Hema-Strip rapid test and confirmed by Western blot. The prevalence of HIV infection was calculated and risk factors associated with infection determined by univariate analyses followed by multivariate modelling. A total of 1517 individuals were interviewed and tested, of whom 1043 adults admitted to donating plasma. The prevalence of HIV infection among plasma donors was 12.5% and among their non-donor spouses was 2.1%. Prevalence was inversely related to educational level and was higher in married participants, but was not associated with medical care, drug abuse or multiple sexual partners. A higher frequency of plasma donation was directly associated with a higher risk of HIV infection. Multivariate analyses demonstrated that being HIV-positive was associated with being 30 to 49 years old [odds ratio (OR) = 1.9], donating both plasma and blood (OR = 2.5), and the frequency of plasma donation (OR = 14 for >10 donations per month). The study demonstrated that the prevalence of HIV infection in the commercial plasma donor population was alarmingly high. Many married individuals and those getting married in the future will transmit the virus to their spouses and future children. Plasma donors need to be alerted to the risk of being infected with HIV and of transmitting HIV to their families and others. Other countries can benefit from the experience of China in reducing the risk of HIV transmission from plasma donating.