HIV-Related High-Risk Behaviors among Chinese Migrant Construction Laborers in Nantong, Jiangsu

Xun Zhuang,Zunyou Wu,Katharine Poundstone,Shengyang Jiang,Changqing Yang,Yaqin Zhong,Sten H Vermund

doi:10.1371/journal.pone.0031986

Abstract

BackgroundHIV transmission in rural areas of China is being fueled in part by migrant workers who acquire HIV outside of their hometowns. Recent surveillance statistics indicate that HIV prevalence among returning migrants has increased significantly.MethodsWe conducted a community-based cross-sectional study to assess HIV-related knowledge, attitudes and behaviors among migrant returnees in Nantong, Jiangsu Province, one of the largest exporters of migrant laborers.ResultsA total of 1625 subjects were enrolled with a response rate of 89%. All participants were male and of the majority Han ethnicity. The mean age was 39.0 years (SD = 6.7; range: 18 to 63), and most had a stable partner (N = 1533, 94.3%). Most correctly identified the major modes of HIV transmission (68.9%–82.0%), but fewer were able to identify ways that HIV cannot be transmitted. Nearly one-third of participants held positive attitudes toward having multiple sex partners, and nearly half believed that sex work should be legalized. Multiple logistic regression analysis indicated that risky sexual behavior (defined as sex with a casual or commercial sex partner) was associated with no stable partner; working abroad; correct condom use; age <22 at first sex; higher coital frequency; and having a positive attitude towards multiple sex partners.ConclusionsWe found high levels of reported sex with a casual or commercial sex partner and low levels of consistent condom use. HIV prevention interventions among migrant workers need to focus on younger migrants, migrants without stable partners, and migrants who travel abroad for work.

Highlights

China’s rapid economic development has been fueled by an unparalleled migration of rural residents to urban centers
In China, surveillance statistics indicate that HIV rates are increasing in many rural areas in which a significant proportion of the population migrates for work
In our sexually active study population consisting of male migrant laborers from Nantong, Jiangsu Province, we found high levels of reported sex with a casual or commercial sex partner; low levels of consistent condom use with casual or commercial sex partners; and extremely low levels of condom use among those with stable partners

Summary

Introduction

China’s rapid economic development has been fueled by an unparalleled migration of rural residents to urban centers. There were an estimated 140 million migrant laborers in China by the end of 2008 [1]. Two thirds of China’s migrants are male, and the vast majority (86%) are under the age of 40 years old [2,3]. Of the many public health consequences of migration, one major concern is HIV vulnerability among male migrant laborers. Constant mobility, hazardous working conditions, low wages, chronic underemployment, and substandard housing are factors that can compromise the health of migrant laborers and make them more vulnerable to HIV [4,8,9]. HIV transmission in rural areas of China is being fueled in part by migrant workers who acquire HIV outside of their hometowns. Recent surveillance statistics indicate that HIV prevalence among returning migrants has increased significantly

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