Abstract
BackgroundTo determine policy implications, this analysis tracks the evolution of HIV/AIDS infection across China to understand current trends and potential risk factors.Methods and Principal FindingsA retrospective study with spatial analytical model and multilevel spatial models was conducted among 326,157 HIV/AIDS cases reported from 1989–2009. The results indicate that the distribution of HIV/AIDS was clustered at the county level with different directional distributions across China from 2003 to 2009. Compared to 2003, by 2009 there was a 122% increase in HIV cases among rural residents, 294% increase among urban residents, 211% increase among migrants, and 237% increase among permanent residents. The overall proportion of HIV by different routes of transmission showed dramatic changes with a 504% increase in sexual transmission of HIV, 90% decrease in blood/plasma transmission, and 35% decrease in injecting drug user transmission. Sexual transmission was the major transmission route among women (44%) and the elderly (59% in men, 44% in women) as well as among permanent (36%) and urban residents (33%). Among those <65 years old, women increased more than men, but among those ≥65 years, men increased more than women. Migrants contributed to the variance of HIV infection between counties but not within counties. The length of highway and urbanization combined with illiteracy were risk factors for HIV/AIDS.Conclusions/SignificanceRates of HIV/AIDS among permanent urban residents, particularly women and elderly men, have increased significantly in recent years. To prevent HIV from spreading further among the general population, additional attention should be paid to these populations as well as to migrants.
Highlights
The first HIV infected patient in China was identified in 1985 in a foreigner at the Peking Union Medical College [1]
After 1995, with increasing market economy and more and more migrant workers, HIV spread across the country [2]
Among 326,157 HIV/AIDS cases in the national HIV/AIDS surveillance system through 2009, 78%, 21% and 1% were reported by HPA, MPA and LPA, respectively; 30% were women, 49% were urban, and 43% were migrants
Summary
The first HIV infected patient in China was identified in 1985 in a foreigner at the Peking Union Medical College [1]. From 1985– 1988, all identified cases, except for four due to contaminated, imported Factor VIII, and were infected overseas. All Chinese nationals are assigned a hukou at birth, which is the place of residence of his/her parents. Before 1980, the hukou system restricted movement from one place to another. With the reform of the Chinese economy starting in 1980, hukou became less restrictive which led to millions of farmers leaving their homes to seek better jobs and a more prosperous life in cities [3]. This analysis tracks the evolution of HIV/AIDS infection across China to understand current trends and potential risk factors
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