Expansion of HIV/AIDS in China: Lessons from Yunnan Province

Abstract

In this article we systematically and critically review the Chinese and English language literature on human immunodeficiency virus (HIV)-related studies in Yunnan Province, Southwestern China. Yunnan Province had the first Chinese HIV outbreak and is still the worst affected area in the nation. Since 1989, HIV infection has extended from injecting drug users into the general population through sexual transmission. Since the economic reform of the 1980s, changed social norms and increased migration have spawned increases in HIV-related risk behaviors such as drug use and commercial sex work. A smaller size of "bridge" populations and lower sexual contact rates between persons in "bridge" and general populations may explain the slower expansion of the HIV epidemic in Yunnan compared to nearby Southeast Asian nations. In 2004, women in antenatal care had a 0.38% HIV prevalence province wide, although >1% infection rates are seen in those counties with high injection drug rates. Patterns of drug trafficking have spread the unusual recombinant HIV subtypes first seen in Yunnan to far-flung regions of China. Increased efforts of Yunnan's HIV control program are correlated with an improved general HIV awareness, but risk behaviors continue at worrisome rates. Future efforts should focus on changing risk behaviors, including harm reduction and condom promotion, especially among the "bridge" groups. The resurgence of commercial sex work in Yunnan, and the high frequency of workers migrating into provinces far from home and family are all sociocultural factors of considerable importance for future HIV and sexually transmitted disease control in China.

HIV Risk Behaviors Among Three Classes of Female Sex Workers in Vietnam

“…If the women already are infected, failure to use condoms puts the men at risk. Both situations create bridges for spreading HIV, AIDS, and other STIs to sexual partners and from these to uninfected populations (Mukandavire & Garira, 2007;Xiao, Kristensen, Sun, Lu, & Vermund, 2007;Zhu et al, 2005), especially if the infected party has not been diagnosed or does not disclose diagnosis to the other. Although the three classes of hospitality workers significantly differed in their demographic characteristics and working conditions, few variables other than occupational status were related to a history of STIs or to current condom use in logistic regression models.…”

Update on diversity and distribution of HIV-1 subtypes in Yunnan province

“…Yunnan province is one of the regions to suffer most from the HIV epidemic in China [1], with over 90 000 residents infected with the virus [2]. This area was the site of the initial HIV-1 outbreak in China in injecting drug users (IDUs) in 1989.…”

The Social Determinants of HIV: A Review

“…Similarly, in Pakistan males appeared to have opportunities to engage in drug use where females did not (35). Although the reason for the disparity was not specifically discussed, it also existed among IDU in Yunan (36). The gender variation was also highly dependent on context.…”

“…In China for instance, nonHan groups make up around 8.1% of the population, but are disproportionately associated with IDU and account for 30% of HIV cases (40). Needle sharing is the predominant source of HIV infection (36). In Malaysia, however, it was the minority ethnic Chinese IDU who had one third the risk of HIV than the ethnic Malays (41).…”