Rural-to-urban migrants and the HIV epidemic in China. AIDS & Behavior, 10, 421-430

Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
AIDS and Behavior (Impact Factor: 3.49). 08/2006; 10(4):421-30. DOI: 10.1007/s10461-005-9039-5
Source: PubMed


China is the next probable frontier for the global HIV epidemic. Central to this anticipated growth of the epidemic is the nation's new and growing population of rural-to-urban migrants. Although there are an estimated 120 million migrants, little information is available about their social and cultural context of their lives in urban areas and their HIV-related perceptions and behaviors. On the basis of the in-depth individual interviews conducted among 90 rural-to-urban migrants in 2 major Chinese cities, Beijing and Nanjing, this qualitative study was designed to explore these issues with a particular focus on their relevance to sexual transmission of HIV. The findings suggest an urgent need for HIV/STI prevention programs that address the cultural, social, and economic constraints facing the migrant population in China.

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Available from: Xiaoyi Fang, Jan 21, 2014
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    • "Fourth, a greater emphasis was placed on perceptions of response costs and self-efficacy in relation to relevant HIV-related risk and protective behaviors and perceptions. As suggested by the extant literature (Hong et al., 2006), most young migrants appear to perceive substantial obstacles (e.g., response costs) to using a condom and lack confidence in their ability to use them (self-efficacy), including feeling inadequate to initiate and/or insist upon the use of condoms. Fifth, the modified version included a greater emphasis on safer sex practices in response to higher rates of sexual risk compared to those among Chinese college students. "
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    ABSTRACT: Our objective was to evaluate the efficacy of a cultural adaptation of a social cognitive theory-based HIV behavioral prevention program among young rural-to-urban migrants in China. The intervention design and assessment were guided by the Protection Motivation Theory (PMT). The intervention was evaluated through a randomized controlled trial with 6-month and 12-month follow-ups. The primary behavioral outcome was the use of condoms. Other outcome measures include HIV knowledge, condom use knowledge, HIV-related perceptions (PMT constructs), and intention to use condom. The mixed-effects regression models for condom use with regular partners indicated that overall frequency of condom use, condom use in last three sexual acts and proper condom use increased over time for the participants but the increases were significantly greater among the intervention group than the control group at 6-month and 12-month follow-ups. The mixed-effects models for HIV-related perceptions indicated that extrinsic rewards, intrinsic rewards, and response costs decreased while vulnerability, severity, response efficacy, and self-efficacy increased over time for the intervention group. The increases in HIV knowledge, condom use knowledge, and intention to use condom were also significantly greater among the intervention group than the control group. The data in the current study suggested efficacy of a social cognitive theory-based behavioral intervention in increasing condom use among young migrants in China. The intervention also increased protective perceptions and decreased risk perception posited by the theory (i.e., PMT).
    AIDS education and prevention: official publication of the International Society for AIDS Education 08/2014; 26(4):296-316. DOI:10.1521/aeap.2014.26.4.296 · 1.51 Impact Factor
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    • "Sexual transmission has been the largest single cause of HIV infection in China, and heterosexual transmission has already become the main mode of transmission [1]. Rural-to-urban migration may be playing a crucial role in the rapid diffusion of HIV [3]. "
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    ABSTRACT: In China, there is increasing concern because of the rapid increase in HIV infection recorded over recent years. Migrant workers are recognized as one of the groups most affected. In this study, HIV/AIDS-related knowledge, attitudes, and behavior among unmarried migrant workers in Shanghai are investigated, with the aim of providing critical information for policy makers and sex educators to reinforce sexual health services and sex health education targeting the behavior and sexual health of unmarried male migrants. A cross-sectional survey was conducted among unmarried male migrant workers in Shanghai, China' largest city and housing the most migrants. A self-administered, anonymous questionnaire was used to collect information on knowledge, attitudes, and behavior associated with increased risk of HIV/AIDS. A total of 2254 subjects were questioned, with a response rate of 91.3%. Among those interviewed, 63.5% reported sexual activities. Misconceptions regarding HIV transmission, poor perception of HIV infection, and low use of condoms were not uncommon. Among those who had sexual intercourse, 73.7% had not used condoms in their last sexual intercourse, and 28.6% reported having engaged in sexual risk behavior (defined as having at least one non-regular partner). Multivariate logistic regression analyses identified several indicators of sexual risk behavior, including younger age at first sexual intercourse (OR: 0.67, 95% CI: 0.31-0.91 for older age at first sexual intercourse), more cities of migration (OR: 2.91, 95% CI: 2.17-3.81 for high level; OR:1.15, 95% CI: 1.06-1.29 for medium level), poor perception of acquiring HIV/AIDS (OR:1.52, 95% CI: 1.33-1.96 for unlikely; OR: 2.38, 95% CI: 1.61-3.70 for impossible), frequent exposure to pornography (OR: 0.33, 95% CI: 0.11-0.43 for never; OR:0.69, 95% CI: 0.60-1.81 for less frequently), not knowing someone who had or had died of HIV/AIDS and related diseases (OR: 2.13, 95% CI: 1.70-2.53 for no), and having peers who engaged in sex with a non-regular sex partner (OR: 4.40, 95% CI: 3.37-5.56 for yes). Today, it is necessary to reinforce sex health education among unmarried migrants and sexual health services should target vulnerable migrant young people.
    BMC Public Health 12/2013; 13(1):1152. DOI:10.1186/1471-2458-13-1152 · 2.26 Impact Factor
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    • "Currently, there are approximately 200 million migrant workers in China, most of whom originated from poorer regions of the country and came to work in the cities as laborers, restaurant workers, and sex workers. The itinerant population is considered as the 'tipping point' for the current HIV/STI epidemic [1,2]. It has been suggested that rural-to-urban migration may play a crucial role in shifting the HIV/AIDS epidemic by broadening social and sexual mixing [3,4]. "
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    ABSTRACT: Background To determine potential social, psychological, and environmental-structural factors that may result in motivating female sex workers (FSWs), who are rural-to-urban migrants, and their paying partners in Shanghai, China to promote consistent condom use (CCU). Methods A cross-sectional study was conducted in five districts of Shanghai, including three suburbs and two downtown locales. We adopted a cluster randomized sampling method to obtain 20 geographic sites, which consisted of 1 or more communities/villages proximal to a location where FSWs were accessible. Five hundred four FSWs from 132 Xitou Fang (shampoo wash rooms), massage parlors, and hair salons who explicitly provided sexual services were enrolled in the study. Each participant completed a questionnaire survey and interview aimed to collect information on the perceptions and behaviors of individuals associated with a risk for human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS),self-efficacy at negotiating safe sex,and the physical, social, and policy environment of the establishments where they worked. Results The percentage of FSWs who reported consistent condom use with their paying partners was 63.3%. Controlling for socio-demographic characteristics in multivariate analyses, environmental-structural support (OR, 3.96; CI, 2.52–6.22) for condom use was the most significant positive predictor of CCU among FSWs and their regular paying partners. A high perception of susceptibility and risk of HIV/AIDS (OR, 1.96; CI, 1.25–3.01), a high perception of benefits on condom use to protect themselves (OR, 2.06; CI, 1.32–3.22), and high safe sex self-efficacy (OR, 2.52; CI, 1.64–3.85) also play important roles on CCU based on multivariate analyses. Conclusions Environmental-structural factor support for condom use, in addition to social, psychological, and individual cognitive factors are significant predictors of CCU among FSWs, which should be assessed and addressed in research and interventions related to HIV/AIDS prevention among FSWs in China.
    BMC Public Health 08/2012; 12(1):599. DOI:10.1186/1471-2458-12-599 · 2.26 Impact Factor
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