Migration and Gender in China’s HIV/AIDS Epidemic

  • M. Giovanna Merli
  • Jack DeWaard
  • Feng Tian
  • Sara Hertog
Part of the The Springer Series on Demographic Methods and Population Analysis book series (PSDE, volume 22)

China today is considered to be a low HIV prevalence country. In 2007 there were an estimated 700,000 HIV cases corresponding to 0.1% of the adult population. HIV infections tend to be concentrated in relatively well-defined population subgroups, such as injecting drug users (IDUs), former plasma and blood donors, and female sex workers (FSWs) and their clients. Despite this low HIV prevalence, the Chinese HIV epidemic is considered to be in the stage of “rapid spread” (Grusky et al. 2002; Qian et al. 2005 cited in Hong and Li 2008), and concerns about a growing epidemic through heterosexual contact persist. Injecting drug users and former commercial blood and plasma donors currently comprise about 55% of all infections, while 44% of infections are among female sex workers, their clients and partners.


Risky Sexual Behavior Sexually Transmitted Disease Female Migrant Male Migrant Sexual Activity Class 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ahmed, S., T. Lutalo, M. Wawer, D. Serwadda, N. Sewankambo, F. Nalugoda, F. Makumbi, F. Wabwire-Mangen, N. Kiwanuka, G. Kigozi, M. Kiddugavu, and R. Gray. 2001. HIV incidence and sexually transmitted disease prevalence associated with condom use: A population study in Rakai,Uganda. AIDS 15(16):2171–2179.PubMedCrossRefGoogle Scholar
  2. Ambroziak, J. and J. A. Levy. 1999. Epidemiology, natural history, and pathogenesis of HIV infection. In Holmes, K. K., P.-A. Mårdh, P. F. Sparling, and P. J. Wiesner (eds.), Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill, pp. 251–258.Google Scholar
  3. Anderson, A. F., Z. Qingsi, X. Hua, and B. Jianfeng. 2003. China’s floating population and the potential for HIV transmission: a social-behavioral perspective. AIDS Care 15(2):177–185.PubMedCrossRefGoogle Scholar
  4. Aral, S., N. S. Padian, and K. K. Holmes. 2005. Advances in multilevel approaches to understanding the epidemiology and prevention of sexually transmitted infections and HIV: An Overview. Journal of Infectious Diseases 191(Suppl 1):S1–S6.PubMedCrossRefGoogle Scholar
  5. Boisier, P., O. N. Ouwe Missi Oukem-Boyer, A. A. Hamidou, F. Sidikou, M. L. Ibrahim, A. E. Mahamane, S. Mamadou, T. S. Aksenenkova, B. H. Modibo, S. Chanteau, A. Sani, and J. P. Louboutin-Croc. 2004. Nationwide HIV prevalence survey in general population in Niger. Tropical Medicine and International Health 9(11):1161–1166.PubMedCrossRefGoogle Scholar
  6. Bracher, M., G. Santow, and S. Watkins. 2003. Moving and marrying: Modeling HIV infection among newly-weds in Malawi. Demographic Research, Special Collection 1, http:/ Scholar
  7. Brockerhoff, M. and A. E. Biddlecom. 1999. Migration, sexual behavior and the risk of HIV in Kenya. International Migration Review 33(4):833–856.CrossRefGoogle Scholar
  8. Chau, P., H. Paul. S. F. Yip, and C. Jisheng. 2003. Reconstructing the incidence of human immunodeficiency virus (HIV) in Hong Kong by using data from HIV positive tests and diagnoses of acquired immune deficiency syndrome. Applied Statistics 52(Part 2):237–248.Google Scholar
  9. Chen, X., Y. Yin, G. Liang, X. Gong, H. Li, G. Poumerol, et al. 2005. Sexually transmitted infections among female sex workers in Yunnan, China. AIDS Patient Care and STDs 19(12):853–860.PubMedCrossRefGoogle Scholar
  10. Chen, Z., G. Zhang, X. Gong, C. Lin, X. Fao, G. Liang, X. Yue, X. Chen, and M. S. Cohen. 2007. Syphilis in China: Results of a national surveillance programme. The Lancet 369:132–369.CrossRefGoogle Scholar
  11. Churat, R., M. Manglani, R. Sharma, and N. K. Shah. 2000. Clinical spectrum of HIV infection. Indian Pediatrics 37:831–836.Google Scholar
  12. Coffee, M., M. N. Lurie, and G. P. Garnett. 2007. Modelling the impact of migration on the HIV epidemic in South Africa. AIDS 21:343–350.PubMedCrossRefGoogle Scholar
  13. Cohen, M., P. Gao, K. Fox, and G. Henderson. 2000. Sexually transmitted diseases in the People’s Republic of China in Y2K: Back to the future. Sexually Transmitted Diseases 27(3):143–145.PubMedCrossRefGoogle Scholar
  14. Decosas, J., F. Kane, J. K. Anarfi, K. D. R. Sodji, and H. U. Wagner. 1995. Migration and AIDS. The Lancet 346:826–828.CrossRefGoogle Scholar
  15. Diez-Roux, A. and A. Aiello. 2005. Multilevel analysis in infectious diseases. Journal of Infectious Diseases 191(Suppl 1):S25–S33.PubMedCrossRefGoogle Scholar
  16. Ding, Y., et al. 2005. HIV infection and sexually transmitted diseases in female commercial sex workers in China. Journal of Acquired Immune Deficiency Syndrome 38(3):314–319.Google Scholar
  17. Downs, A. M. and I. De Vincenzi. 1996. Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology 11:388–395.Google Scholar
  18. Edlund, L. and E. Korn. 2002. A theory of prostitution. The Journal of Political Economy 110(1):181–214.CrossRefGoogle Scholar
  19. du Guerny, J., L.-N. Xsu, and C. Hong. 2003. Population movement and HIV/AIDS. The case of Ruili, Yunnan, China. UNDP South East Asia HIV and Development Programme. August 2003.Google Scholar
  20. Fan, C. C. 2000. Migration and gender in China. In C. M. Lau and J. Shen (eds.). China Review 2000. Hong Kong: Chinese University Press, pp. 423–454.Google Scholar
  21. Fan, C. C. 2003. Rural-urban migration and gender division of labor in China. International Journal of Urban and Regional Research 27(1):24–47.CrossRefGoogle Scholar
  22. Farrer, J. 2002. Opening Up: Youth Sex Culture and Market Reform in Shanghai. Chicago: University of Chicago Press.Google Scholar
  23. Fleming, D. T. and J. N. Wasserheit. 1999. From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections 75:3–17.PubMedCrossRefGoogle Scholar
  24. Fylkesnes, K., R. M. Musonda, K. Kasumba, Z. Ndhlovu, F. Mluanda, L. Kaetano, and C. C. Chipalia. 1997. The HIV epidemic in Zambia: sociodemographic prevalence patterns and indications of trends among childbearing women. AIDS 11: 339–345.PubMedCrossRefGoogle Scholar
  25. Garnett, G. and R. M. Anderson. 1993. Factors controlling the spread of HIV in heterosexual communities in developing countries: Patterns of mixing between different age and sexual activity classes. Philosophical Transactions: Biological Sciences 342(1300):137–159.CrossRefGoogle Scholar
  26. Gill, B., J. Chang, and S. Palmer. 2002. China’s HIV Crisis. Foreign Affairs 81(2).Google Scholar
  27. Gong, X., Y. Shunzhang, Z. Junyan, Z. Guocheng, S. Changgeng, L. Guojun, J. Wenhua, X. Qiang, and W. Quanpei. 2002. Epidemiological situation of sexually transmitted diseases in China: From 1991 to 2001. (In Chinese) Chinese Journal of Dermatology 35(3).Google Scholar
  28. Goodkind, D. 2006. “Marriage squeeze in China: Historical legacies, surprising findings.” Presented at the 2006 Annual Meeting of the Population Association of America, Los Angeles, March 30-April 1, 2006.Google Scholar
  29. Grusky, O., H. Liu, and M. Johnston. 2002. HIV/AIDS in China: 1990–2001. AIDS & Behavior 6:381–393.CrossRefGoogle Scholar
  30. He, N., R. Detels, Z. Chen, Q. Jiang, J. Zhu, Y. Dai, et al. 2006. Sexual behavior among employed male rural migrants in Shanghai, China. AIDS Education and Prevention 18(2):176–186.PubMedCrossRefGoogle Scholar
  31. Hertog, S. 2007. Heterosexual behavior patterns and the spread of HIV/AIDS: The interacting effects of rate of partner change and sexual mixing. Sexually Transmitted Diseases August 30.Google Scholar
  32. Hesketh, T., L. Li, X. Ye, H. Wang, M. Jiang, and A. Tomkins. 2005. HIV and syphilis in migrant workers in eastern China. Sexually Transmitted Infections 82:11–14.CrossRefGoogle Scholar
  33. Hong, Y., B. Stanton, X. Li, H. Yang, D. Lin, X. Fang, J. Wang, and R. Mao. 2006. Rural to urban migrants and the HIV epidemic in China. AIDS and Behavior 10: 421–430.PubMedCrossRefGoogle Scholar
  34. Hong, Y. and X. Li. 2008. Behavioral Studies of Female Sex Workers in China: A Literature Review and Recommendations for Future Research. AIDS and Behavior 12:623–636.PubMedCrossRefGoogle Scholar
  35. Horizon Market Research and Futures Group Europe. 2002. 2001 Behavioural Surveillance Survey in Yunnan and Sichuan. Sex Workers Report. December 2002.Google Scholar
  36. Huang, P. and Z. Shaohua. 2005. “Internal migration in China: Linking it to development.” Paper presented at the Regional Conference of Migration and Development in Asia, Lanzhou China 14–16 March 2005.Google Scholar
  37. Huang, Y. 2001. Gender, hukou, and the occupational attainment of female migrants in China (1985–1990). Environment and Planning 33(2):257–279.CrossRefGoogle Scholar
  38. Huang, Y., G. E. Henderson, S. Pan, and M. S. Cohen. 2004. HIV/AIDS risk among brothel-based female sex workers in China: Assessing the terms, content, and knowledge of sex work. Sexually Transmitted Diseases 31:695–700.PubMedCrossRefGoogle Scholar
  39. Hudson, V. M. and A. M. den Boer. 2004. Bare Branches: The Security Implications of Asia’s Surplus Male Population. Boston: MIT Press.Google Scholar
  40. Hunt, C. W. 1989. Migrant labor and sexually transmitted disease: AIDS in Africa. Journal of Health and Social Behavior 30:353–373.PubMedCrossRefGoogle Scholar
  41. Kaufman, J. and J. Jing. 2002. China and AIDS – The time to act is now. Science 296(28 June 2002):2339–2340.PubMedCrossRefGoogle Scholar
  42. Lagarde, E., G. Pison, and C. Enel. 1996. A study of sexual behavior change in rural Senegal. Journal of Acquired Immune Deficiencies Syndromes and Human Retrovirology 11:282–287.Google Scholar
  43. Landoni, M. 2006. “Two scenarios on Chinese population dynamics based on a multiregional projection model.” Paper presented at the European Population Conference, Liverpool, 21–24 June, 2006.Google Scholar
  44. Lau, J., H. Tsui, P. Siah, and K. Zhang. 2002. A study on female sex workers in southern China (shenzhen): HIV-related knowledge, condom use, and STD history. AIDS Care 14(2):219–233.PubMedCrossRefGoogle Scholar
  45. Leclerc, P. M. and M. Garenne. 2007. Inconsistencies in age profile of HIV prevalence: A dynamic model applied to Zambia. Demographic Research 16(5):121–140.CrossRefGoogle Scholar
  46. Li, X., X. Fang, D. Lin, R. Mao, J. Wang, L. Cottrell, C. Harris, and B. Stanton. 2004. HIV/STI risk behaviors and perceptions among rural-to-urban migrants in China. AIDS Education and Prevention 16(6):538–556.PubMedCrossRefGoogle Scholar
  47. Liang, Z. and Z. Ma. 2004. China’s floating population: New evidence from the 2000 Census. Population and Development Review 30:467–488.CrossRefGoogle Scholar
  48. Liao, S. S., J. Schensul, and I. Wolffers. 2003. Sex-related health risks and implications for interventions with hospitality women in Hainan, China. AIDS Education and Prevention 15(2):109–121.PubMedCrossRefGoogle Scholar
  49. Lim, L. L. 1998. The Sex Sector. The Economic and Social Basis of Prostitution in Southeast Asia. Geneva: International Labour Office.Google Scholar
  50. Lurie, M., A. Harrison, D. Wilkinson, and S. S. Abdool Karim. 1997. Circular migration and sexual networking in rural South Africa: Implications for the spread of HIV and other sexually transmitted diseases. Health Transition Review 7(Suppl. 3):15–24.Google Scholar
  51. Lurie, M. N., G. Brian, B. G. Williams, K. Zuma, D. Mkaya-Mwamburi, G. Garnett, A. W. Sturm, M. Sweat, J. Gittelsohn, and S. A. Karim. 2003. The impact of migration on HIV-1 transmission in South Africa. Sexually Transmitted Diseases 30: 149–156.PubMedCrossRefGoogle Scholar
  52. Mastro, T. D. and I. de Vincenzi. 1996. Probabilities of sexual HIV-1 transmission. AIDS 10(suppl A):S75–S82.PubMedCrossRefGoogle Scholar
  53. Merli, M. G., S. Hertog, B. Wang, and J. Li. 2006. Modeling the spread of HIV/AIDS in China: The role of sexual transmission. Population Studies 60(1):1–22.CrossRefGoogle Scholar
  54. Merli, M. G. and S. Hertog. 2007. Masculine sex ratios, migration and the spread of HIV in China. Presented at the Population Association of America Meetings, New York, NY April 2007.Google Scholar
  55. MOH, UNAIDS, and WHO. 2006. People’s Republic of China Ministry of Health, Joint UN Program on HIV/AIDS and World Health Organization (WHO). 2006. 2005 Update on the HIV/AIDS Epidemic and Response in China. Beijing: National Center for AIDS/STD Prevention and Control.Google Scholar
  56. Morris, M., C. Podhisita, M. J. Wawer, et al. 1996. Bridge populations in the spread of HIV/AIDS in Thailand. AIDS (10):1265–1271.Google Scholar
  57. Nunn, A. J., H. U. Wagner, A. Kamali, J. F. Kengeya-Kayondo, and D. W. Mulder. 1995. Migration and HIV-1 Seroprevalence in a rural Ugandan population. AIDS 9: 503–506.PubMedCrossRefGoogle Scholar
  58. Palloni, A. 1996. Demography of HIV/AIDS. Population Index 62(4):601–652.CrossRefGoogle Scholar
  59. Palloni, A. and L. Lamas. 1991. The Palloni approach: A duration-dependent model of the spread of HIV/AIDS in Africa. In The AIDS Epidemic and its Demographic Consequences. New York: United Nations, Department of International Economic and Social Affairs and World Health Organization, Global Programme on AIDS.Google Scholar
  60. Parish, W., E. O. Laumann, M. S. Cohen, S. Pan, H. Zheng, H. Irving, T. Wang, and K. H. Ng. 2003. Population-based study of Clamydial infection in China: A hidden epidemic. JAMA 289(10):1265–1273.PubMedCrossRefGoogle Scholar
  61. Parrado, E. and C. A. Flippen. 2006. “Migration and sexuality: A comparison of Mexicans in sending and receiving communities.” Presented at the Population Association of America Annual Meetings, Los Angeles, CA. March 30-April 1, 2006.Google Scholar
  62. Pettifor, A. E., H. V. Rees, I. Kleinschmidt, A. E. Steffenson, C. MacPhail, L. Hlongwa-Madikizela, K. Vermaak, and N. S. Padian. 2005. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviours from a nationally representative household survey. AIDS 19:1525–1534.PubMedCrossRefGoogle Scholar
  63. Pilcher, C. D., H. C. Tien, J. J. Eron, Jr., P. L. Vernazza, S.-Y. Leu, P. W. Stewart, L.-E. Goh, and M. S. Cohen. 2004. Brief but efficient: Acute HIV infection and the sexual transmission of HIV. The Journal of Infectious Diseases 189:1785–1792.PubMedCrossRefGoogle Scholar
  64. Pison, G. B. Le Guenno, E. Lagarde, C. Enel, and C. Seck. 1993. Seasonal migration: A risk factor for HIV infection in rural Senegal. Journal of Acquired Immune Deficiency Syndromes 6(2):196–200.PubMedGoogle Scholar
  65. PRED Bank (Population, Resources, Environment and Development Databank: the 2005 Revision). 2006. New York: United Nations. pop/dVariables/DRetrieval.aspxGoogle Scholar
  66. Qian, H. Z., S. H. Vermund, and N. Wang. 2005. Risk of HIV/AIDS in China: Subpopulations of special importance. Sexually Transmitted Infections 81:442–447.PubMedCrossRefGoogle Scholar
  67. Quigley, M., K. Mungut, H. Grosskurth, J. Todd, F. Mosha, K. Senkoro, J. Newell, P. Mayaud, G. ka-Gina, A. Klokke, D. Mabey, A. Gavyole, and R. Hayes. 1997. Sexual behaviour patterns and other risk factors for HIV infection in rural Tanzania: A case-control study. AIDS 11:237–248.PubMedCrossRefGoogle Scholar
  68. Retherford, R. D., M. K. Choe, C. Jiajian, L. Xiru, and C. Hongyan. 2005. Fertility in China: how much has it really declined? Population and Development Review 31(1):57–84.CrossRefGoogle Scholar
  69. Roberts, K. 2002. Female labor migrants to Shanghai: Temporary “floaters” or potential settlers? International Migration Review 36(2):492–519.Google Scholar
  70. Ruan, Y., X. Cao, and H. Qian. 2006. Syphilis among female sex workers in southwestern China: Potential for HIV transmission. Sexually Transmitted Diseases 33(12):719–723.PubMedCrossRefGoogle Scholar
  71. Saracco, A., M. Musicco, A. Nicolosi, G. Angarano, C. Arici, G. Gavazzeni, P. Costigliola, S. Gafa, C. Gervasoni, R. Luzzati, F. Peccinino, F. Puppo, B. Salassa, A. Sinicco, R. Stellini, U. Terelli, G. Turbessi, G. M. Vigevani, G. Visco, R. Zerboni, and A. Lazzarin. 1993. Male-to-female sexual transmission of HIV: longitudinal study of 343 steady partners of infected men. Journal of Acquired Immune Deficiency Syndrome 6(5):497–502.CrossRefGoogle Scholar
  72. Schafer, S. 2003. Not just another pretty face. Newsweek October 13, 2003. http:// Scholar
  73. Seidlin, M., M. Vogler, E. Lee, Y. S. Lee, and N. Dubin. 1993. Heterosexual transmission of HIV in a cohort of couples in New York City. AIDS 7(9):1247–1254.PubMedCrossRefGoogle Scholar
  74. Sigley, G. and E. Jeffreys. 1999. On ‘sex’ and ‘sexuality’ in China: A conversation with Pan Suiming. Bulletin of Concerned Asian Scholars 31(1):50–58.Google Scholar
  75. Solinger, D. 1999. Contesting Citizenship: Peasants, Migrants, the State, and the Logic of the Market in Urban China. Berkeley and Los Angeles: University of California Press.Google Scholar
  76. Thomas, D., E. Frankenberg, and J. Smith. 2000. Lost but not forgotten. Attrition and followup in the Indonesia Family Life Survey. The Journal of Human Resources XXXVI(3):556–592.Google Scholar
  77. Tucker, J. D., G. E. Henderson, T. F. Wang, Y. Y. Huang, W. Parish, S. M. Pan, X. S. Chen, and M. S. Cohen. 2005. Surplus men, sex work, and the spread of HIV in China. AIDS 19(6):539–547.PubMedCrossRefGoogle Scholar
  78. Tuljapurkar, S., N. Li, and M. Feldman. 1995. High sex ratios in China’s future. Science 267(5199):874–876.PubMedCrossRefGoogle Scholar
  79. van den Hoek, A., F. Yuliang, N. H. T. M. Dukers, C. Zhiheng, F. Jiangting, Z. Lina, and Z. Xiuxing. 2001. High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: Potential for fast spread of HIV. AIDS 15:753–759.PubMedCrossRefGoogle Scholar
  80. Wang, B., X. Li, B. Stanton, H. Yang, X. Fang, R. Zhao, et al. 2005. Vaginal douching, condom use, and sexually transmitted infections among Chinese female sex workers. Sexually Transmitted Diseases 32(11):696–702.PubMedCrossRefGoogle Scholar
  81. Wang, F. 1997. The breakdown of a Great Wall: Recent changes in household registration system in China. In T. Scharping (ed.). Floating Population and Migration in China: the Impact of Economic Reforms. Hamburg: Institute of Asian Studies, pp. 149–165.Google Scholar
  82. Wang, J., H. Yang, X. Li, B. Stanton, X. Fang, D. Lin, and R. Mao. 2004. “Venue patterns of HIV-related sexual behaviors and perceptions among female migrant workers.” Paper presented at the International Conference on AIDS, July 11–16, 2004.Google Scholar
  83. Wawer, M. J., N. K. Sewankambo, S. Berkley, D. Serwadda, S. D. Musgrave, R. H. Gray, M. Musagara, R. Y. Stallings, and J. K. Konde-Lule. 1994. Incidence of HIV-1 infection in a rural region of Uganda. British Medical Journal 308(6922):171–173.PubMedGoogle Scholar
  84. Xia, G. and X. Yang. 2005. Risky sexual behavior among female entertainment workers in China: Implications for HIV/STD prevention intervention. AIDS Education and Prevention 17(2):143–156.PubMedCrossRefGoogle Scholar
  85. Yang, X. 2005. Does where we live matter? Community characteristics and HIV/STD prevalence in Southwestern China. International Journal of STD and AIDS 16(1): 31–37.PubMedCrossRefGoogle Scholar
  86. Yang, X., V. J. Derlega, and H. Luo. 2005. “Migration, behavior change, and HIV/STD risks in China.” Paper presented to the IUSSP meetings, Tours, France, August 2005.Google Scholar
  87. Yang, X. and G. Xia. 2006. Gender, migration, risky sex and HIV infection in China. Studies in Family Planning 37(4):241–250.PubMedCrossRefGoogle Scholar
  88. Yang, X. and G. Xia. 2008. “Temporary Migration and STD/HIV Risky Sexual Behavior: A Population-Based Analysis of Gender Differences in China.” Paper presented at the Annual Meetings of the Population Association of America, New Orleans, April 17–19, 2008.Google Scholar
  89. Yuan, J., X. Yi, J. Tao, W. Mei, L. Yaqing, L. Kejun, Q. Shuquan, B. Yue, W. Lingyun, L. Bollinger, N. Walker, H. Jingling, and G. Ionita. 2002. The Socioeconomic Impact of HIV/AIDS in China. August 2002. english/resources/Ourreports/SocEc%20Impact%20study.pdfGoogle Scholar
  90. Zhang, K. and S. Ma. 2002. Epidemiology of HIV in China: Intravenous drug users, sex workers, and large mobile populations are high risk groups. BMJ 324:803–804.CrossRefGoogle Scholar
  91. Zhong, N., Y. Lu, and F. Wang. 2002. Syphilis surveillance among 3,939 prostitutes. China Tropical Medicine 2:100–101.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • M. Giovanna Merli
    • 1
  • Jack DeWaard
    • 1
  • Feng Tian
    • 1
  • Sara Hertog
    • 1
  1. 1.Terry Sanford Institute of Public Policy at Duke UniversityDurhamUSA

Personalised recommendations