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How Bachelorhood and Migration Increase the HIV Transmission Risk Through Commercial Sex in China?


In China, the serious involuntary bachelorhood due to sex ratio imbalance in decades is expected to dramatically increase the spread of HIV through heterosexual contact. However, the higher HIV transmission risk and its correlates among never married men in rural China are not well understood. This study explored whether and how bachelorhood and migration increased the HIV transmission risk through commercial sex. By combining two cross-sectional survey data from never married men in rural areas and male migrants (including both married and unmarried men) in urban areas, a total of 1030 participants who were never married and age 28 and above or married male migrants were included in this study. The results show that both bachelorhood and migration put the never married male migrants at particularly higher HIV transmission risk by increasing both the possibility of engaging in commercial sex, and the frequency and inconsistency of condom use in commercial sex. Selection bias into marriage and neighborhood characteristics associated with exposure to commercial sexual risk may partly explain why male migrants that never married had a higher commercial sex related risk than that of married male migrants and never married non-migrant males.


En China, se anticipa que la gravedad de la soltería involuntaria causada por decenios de desequilibrio entre la proporción de sexos aumente drásticamente la propagación del VIH a través del contacto heterosexual. Sin embargo, el mayor riesgo de transmisión del VIH y sus correlatos entre aquellos hombres que nunca se han casado ​​y que habitan en las zonas rurales de China no se conocen bien. Este estudio exploró la posibilidad y la manera en que la soltería y la migración aumentaron el riesgo de transmisión del VIH a través del sexo comercial. Al combinar dos datos de encuestas transversales de hombres que nunca se han casado ​​en áreas rurales y hombres migrantes (incluidos hombres casados ​​y solteros) en áreas urbanas, un total de 1030 participantes que nunca se casaron y tenían 28 años o más o que eran hombres migrantes casados fueron incluidos en este estudio. Los resultados muestran que tanto la soltería como la migración ponen a los migrantes varones que nunca se han casado ​​en un riesgo de transmisión del VIH particularmente mayor al aumentar tanto la posibilidad de tener relaciones sexuales comerciales como la frecuencia y uso inconsistente del condón. El sesgo de selección en las características del matrimonio y las particularidades del vecindario asociadas con la exposición al riesgo que trae consigo el sexo comercial en parte explica porque los hombres migrantes que nunca se han casado tuvieron un riesgo relacionado con el sexo comercial más alto que el de los hombres migrantes casados ​​y los hombres no migrantes que nunca se han casado.

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  1. 1.

    Huang MB, Ye L, Liang BY, et al. Characterizing the HIV/AIDS epidemic in the United States and China. Int J Environ Res Public Health. 2016;13(1):30.

  2. 2.

    Phanuphak N, Lo YR, Shao Y, et al. HIV epidemic in Asia: implications for HIV vaccine and other prevention trials. AIDS Res Hum Retroviruses. 2015;31(11):1060–76.

  3. 3.

    NCAIDS, NCSTD, China CDC. Update on AIDS/STD epidemic in China in December 2017. Chin J AIDS STD. 2018;24(2):111–2 In Chinese.

  4. 4.

    Yang H, Li X, Stanton B, et al. Heterosexual transmission of HIV in China: a systematic review of behavioral studies in the past two decades. Sex Transm Dis. 2005;32(5):270–80.

  5. 5.

    Zhu J, Yuan R, Hu D, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors of female sex workers and male clients in a border region of Yunnan province, China. Int J STD AIDS. 2018;29(5):424–34.

  6. 6.

    Zhang C, Li X, Hong Y, Zhou Y, Liu W, Stanton B. Unprotected sex with their clients among low-paying female sex workers in southwest China. AIDS Care. 2013;25(4):503–6.

  7. 7.

    Han L, Zhou C, Li Z, et al. Differences in risk behaviors and HIV/STI prevalence between low-fee and medium-fee female sex workers in three provinces in China. Sex Transm Infect. 2016;92:309–15.

  8. 8.

    Chen L, His J, Wu X, et al. Disparities in HIV and syphilis prevalence and risk factors between older male clients with and without steady sex partners in southwestern rural China. BMC Infect Dis. 2017;17:269.

  9. 9.

    Poston DL, Glover KS. Too many males: marriage market implications of gender imbalances in China. Genus. 2005;61(2):119–40.

  10. 10.

    Banister J. Shortage of girls in China today. J Popul Res. 2004;21(1):19–45.

  11. 11.

    Das Gupta M, Li S. Gender bias in China, South Korea and India 1920–1990: the effects of war, famine, and fertility decline. Dev Change. 1999;30(3):619–52.

  12. 12.

    Jiang Q, Sánchez-Barricarte JJ, Li S, Feldman MW. Marriage squeeze in China’s future. Asian Popul Stud. 2011;7(3):177–93.

  13. 13.

    Poston DL Jr, Conde E, DeSalvo B. China’s unbalanced sex ratio at birth, millions of excess bachelors and societal implications. Vulnerable Children and Youth Studies: an International Interdisciplinary. J Res Policy Care. 2011;6(4):314–20.

  14. 14.

    Jiang Q, Feldman M, Li S. Marriage squeeze, never-married proportion, and mean age at first marriage in China. Popul Res Policy Rev. 2014;33(2):189–204.

  15. 15.

    Isabelle A, Zhang Q, Li S, Yang X, Guilmoto CZ. Bachelorhood and sexuality in a context of female shortage: evidence from a survey in rural Anhui, China. China Q. 2013;215:703–26.

  16. 16.

    Yang X, Li S, Attane I, Feldman MW. Commercial sex behaviours among involuntary male bachelors: findings from a survey of migrants in Xi’an, China. J Public Health (Oxf). 2014;37(2):305–12.

  17. 17.

    Tucker JD, Henderson GE, Wang TF, et al. Surplus men, sex work, and the spread of HIV in China. AIDS. 2005;19(6):539–47.

  18. 18.

    Kobori E, Visrutaratna S, Kada A, Wongchai S, Ono-Kihara M, Kihara M. Prevalence and correlates of sexual behaviors among Karen villagers in northern Thailand. AIDS Behav. 2007;11(4):611–8.

  19. 19.

    Leclerc PM, Garenne M. Clients of commercial sex workers in Zambia: prevalence, frequency, and risk factors. Open Demogr J. 2008;1:1–10.

  20. 20.

    Morris M, Pramualratana A, Podhisita C, Wawer MJ. The relational determinants of condom use with commercial sex partners in Thailand. AIDS. 1995;9(5):507–15.

  21. 21.

    Yang X, Attané I, Li S. Commerical sex and condom use among involuntary bachelors: an exploratory survey in rural China. Am J Mens Health. 2014;8(3):205–16.

  22. 22.

    Hesketh T, Zhu W. Abnormal sex ratios in human populations: causes and consequences. Proc Natl Acad Sci USA. 2006;103(36):13271–5.

  23. 23.

    Jiang Q, Sánchez-Barricarte JJ. Bride price in China: the obstacle to ‘bare branches’ seeking marriage”. Hist Fam. 2012;17(1):2–15.

  24. 24.

    Wu H. The Analysis of the determinants of the forced male bachelors in rural areas: results from the survey in Hebei province. Popul Dev. 2013;19(3):92–7 In Chinese.

  25. 25.

    Yang B, Li S. Social risk of HIV/AIDS transmission among migrant males in marriage squeeze society: analysis on risky sexual behaviors. J Xi’an Jiaotong Univ (Social Sciences). 2016;36:100–7 In Chinese.

  26. 26.

    Liu H, Li S, Feldman MW. Forced bachelors, migration and HIV transmission risk in the context of China’s gender imbalance: a meta-analysis. AIDS Care. 2012;24(12):1487–95.

  27. 27.

    National Bureau of Statistics of China. Statistical communiqué of the People’s Republic of China on the 2017 National Economic and Social Development. (2019). Accessed 27 Feb 2019.

  28. 28.

    Tucker JD, Poston DL, Ren Q, et al. Gender policy and HIV in China. The Springer series on demographic methods and population analysis, vol. 22. Cham: Springer; 2009. p. 1–6.

  29. 29.

    Liu H. Quality of life of old-unmarried men in rural China: present and future. Popul Soc. 2017;1:33–43 In Chinese.

  30. 30.

    Olawore O, Tobian A, Kagaayi J, et al. Migration and risk of HIV acquisition in Rakai, Uganda: a population-based cohort study. Lancet HIV. 2018;5:e181–9.

  31. 31.

    McGrath N, Eaton JW, Newell M, et al. Migration, sexual behaviour, and HIV risk: a general population cohort in rural South Africa. Lancet HIV. 2015;2:e252–9.

  32. 32.

    Gandhi AD, Pettifor A, Barrington C, et al. Migration, multiple sexual partnerships, and sexual concurrency in the Garífuna population of Honduras. AIDS Behav. 2015;19:1559–70.

  33. 33.

    Michalopoulos LM, Jiwatram-Negron T, Gilbert L, et al. Traumatic events and HIV sexual risk behaviors among migrant and non-migrant male market workers in central Asia. AIDS Behav. 2018;22:3480–90.

  34. 34.

    Hu Z, Liu H, Li X, Stanton B, Chen X. HIV-related sexual behaviour among migrants and non-migrants in a rural area of China: role of rural-to-urban migration. Public Health. 2006;120:339–45.

  35. 35.

    Li X, Zhang L, Stanton B, Fang X, Xiong Q, Lin D. HIV/AIDS-related sexual risk behaviors among rural residents in China: potential role of rural-to-urban migration. AIDS Educ Prev. 2007;19:396–407.

  36. 36.

    Dai W, Gao J, Gong J, et al. Sexual behavior of migrant workers in Shanghai, China. BMC Public Health. 2015;15:1067.

  37. 37.

    Wu JQ, Wang KW, Zhao R, et al. Male rural-to-urban migrants and risky sexual behavior: a cross sectional study in Shanghai, China. Int J Environ Res Public Health. 2014;11:2846–64.

  38. 38.

    Li WW, Jiang JJ, Su JM, et al. Commercial sexual behaviors among male rural-to-urban migrants in western China: implications for HIV prevention. Asia Pac J Public Health. 2017;29(5):388–400.

  39. 39.

    Apostolopoulos Y, Sonmez S, Kronenfeld J, Castillo E, McLendon L, Smith D. STI/HIV risks for Mexican migrant laborers: exploratory ethnographies. J Immigr Minor Health. 2006;8(3):291–2.

  40. 40.

    Winett L, Harvey SM, Branch M, Torres A, Hudson D. Immigrant Latino men in rural communities in the Northwest: social environment and HIV/STI risk. Cult Health Sex. 2011;13(6):643–56.

  41. 41.

    Hirsch JS. Labor migration, externalities and ethics: theorizing the meso-level determinants of HIV vulnerability. Soc Sci Med. 2014;100:38–45.

  42. 42.

    Cooper HLF, Linton S, Haley DF, et al. Changes in exposure to neighborhood characteristics are associated with sexual network characteristics in a cohort of adults relocating from public housing. AIDS Behav. 2015;19:1016–30.

  43. 43.

    Browning CR, Burrington LA, Leventhal T, Brooks-Gunn J. Neighborhood structural inequality, collective efficacy, and sexual risk behavior among urban youth. J Health Soc Behav. 2008;49:269–85.

  44. 44.

    Burns PA, Snow RC. The built environment & the impact of neighborhood characteristics on youth sexual risk behavior in Cape Town, South Africa. Health Place. 2012;18(5):1088–100.

  45. 45.

    Davey-Rothwell MA, Siconolfi DE, Tobin KE, Latkin CA. The role of neighborhoods in shaping perceived norms: an exploration of neighborhood disorder and norms among injection drug users in Baltimore, MD. Health Place. 2015;33:181–6.

  46. 46.

    Latkin CA, Curry AD, Hua W, Davey MA. Direct and indirect associations of neighborhood disorder with drug use and high-risk sexual partners. Am J Prev Med. 2007;32(6S):S234–41.

  47. 47.

    Frye V, Nandi V, Egan JE, et al. Associations among neighborhood characteristics and sexual risk behavior among Black and White MSM living in a major urban area. AIDS Behav. 2017;21:870–90.

  48. 48.

    Jones J, Salazar LF, Crosby R. Contextual factors and sexual risk behaviors among young, Black men. Am J Mens Health. 2017;11(3):508–17.

  49. 49.

    Frye V, Koblin B, Chin J, et al. Neighborhood-level correlates of consistent condom use among men who have sex with men: a multi-level analysis. AIDS Behav. 2010;14:974–85.

  50. 50.

    Kelly BC, Carpiano RM, Easterbrook A, Parsons JT. Sex and the community: the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men. Sociol Health Illn. 2012;34(7):1085–102.

  51. 51.

    Raymond HF, Chen YH, Syme SL, Catalano R, Hutson MA, McFarland W. The role of individual and neighborhood factors: HIV acquisition risk among high-risk populations in San Francisco. AIDS Behav. 2014;18:346–56.

  52. 52.

    Bowleg L, Neilands TB, Tabb LP, Burkholder GJ, Malebranche DJ, Tschann JM. Neighborhood context and black heterosexual men’s sexual HIV risk behaviors. AIDS Behav. 2014;18:2207–18.

  53. 53.

    Liu H. Quality of life of old-unmarried men in rural China: present and future. Popul Soc. 2017;33(1):33–43 In Chinese.

  54. 54.

    Sharygin E, Ebenstein A, Das Gupta M. Implications of China’s future bride shortage for the geographical distribution and social protection needs of never-married men. Popul Stud (Camb). 2013;67(1):39–59.

  55. 55.

    Parrado EA, Flippen CA, McQuiston C. Use of commercial sex workers among Hispanic migrants in North Carolina: implications for the spread of HIV. Perspect Sex Reprod Health. 2004;36(4):150–6.

  56. 56.

    Celentano DD, Nelson KE, Suprasert S, et al. Behavioral and sociodemographic risks for frequent visits to commercial sex workers among northern Thai men. AIDS. 1993;7(12):1647–52.

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Data collection for this study was possible thanks to financial support of National Nature Science Foundation of China (71573202). We are very grateful for the funding.

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Correspondence to Huijun Liu.

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The study was approved by the Research Ethics Committee, Xi’an Jiaotong University (No: 2016-415). The workers who participated in this study gave written informed consent.

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Xiao, Q., Liu, H. & Wu, B. How Bachelorhood and Migration Increase the HIV Transmission Risk Through Commercial Sex in China?. AIDS Behav 24, 791–801 (2020).

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  • Bachelorhood
  • Migration
  • HIV transmission risk
  • Commercial sex

Palabras clave

  • Soltería
  • Migración
  • riesgo de transmisión del VIH
  • Sexo comercial