Bare Branches, Prostitution, and HIV in China: A~Demographic Analysis

Abstract

The alarming rise in China’s reported HIV cases in the last decade has caused concern among government officials and public health researchers. The increase in reported HIV cases is especially worrying because the majority of new cases are not observed in traditional high risk populations (such as intravenous drug users and recipients of former plasma donors), but are sexually transmitted. This chapter analyzes the demographic patterns in China that may be an important determinant of the increase in sexually transmitted HIV infections. High sex ratios, numbers of men relative to numbers of women, in young cohorts of Chinese men and women contribute to the increasing failure of Chinese men to marry. These men, referred to as bare branches (guang gun) since they will be unable to extend the family tree, are more likely to migrate to regions with more favorable marriage markets, and may be more likely to purchase sex. This behavior in turn increases men’s risk of sexually transmitted infections, including HIV. We also analyze how further increases in sex ratios among Chinese men and women of marrying ages may affect migration patterns, commercial sex demand, and the spread of HIV. We begin the analysis in the second section with a brief history of HIV in China during the last two decades. In the third section, we present forecasts for demographic changes in China in the 21st century, describing how the entry of cohorts with highly skewed sex ratios into the marriage pool may result in large numbers of males marrying late, or failing to marry. In the fourth section considers how the imbalanced sex ratios and socio-economic