Prevalence and Trends of HIV, Syphilis, and HCV in Migrant and Resident Men Who Have Sex with Men in Shandong, China: Results from a Serial Cross-Sectional Study

Abstract

BackgroundMigrant men who have sex with men (MSM) have a higher predisposition for HIV transmission. We aimed to determine and compare the prevalence and trends of HIV, Syphilis, and HCV between migrant and resident MSM in Shandong, China.MethodsA serial cross-sectional study was conducted in eight cities in Shandong, China from 2010 to 2014. The surveys collected information on demographics, HIV-related knowledge, and HIV-related behaviors including the serologic status of HIV, syphilis, and HCV. Bivariate and multivariable logistic regressions were used to determine differences between migrant and resident MSM.ResultsThe overall prevalence of HIV among the 15,705 MSM (14120 were resident, 1580 were migrant and 5 were missing) was 2.6%, with an increase of 1.0% in 2010 to 4.4% in 2014. Prevalence of HIV was higher among migrant MSMs (5.5%) compared to resident MSMs (2.3%). Compared to residents, migrants also had higher prevalence of syphilis (7.5% vs 4.9%) and HCV (1.1% vs 0.6%). We found that there was an increase in the proportion of migrant MSM engaging in anal sex [adjusted OR (AOR) = 1.41 in migrants vs 1.12 in residents], condom use during last anal sex (AOR = 1.14 in residents, P for trend = 0.32), consistent condom use (AOR = 1.04 residents, P for trend = 0.11) and drug use (AOR = 1.51 in migrants and 1.29 among residents). Except in the year 2011, receiving some health services in last year was significant for people who were HIV-positive compared to negative. (P for trend <0.05).ConclusionsPrevalence of HIV increased in resident as well as migrant MSMs. The migrant MSMs had higher STIs compared to resident MSMs and therefore, should be targeted for effective interventions aimed at reducing their risk behaviors. Deeper understanding of the role of migration in health issues is required for combating the persistently high and gradually increasing HIV burden in MSM in China.

Transplantation or rurality? Migration and HIV risk among Chinese men who have sex with men in the urban areas

“…Compromised HIV testing and other healthcare utilization patterns among rural transplants suggests that attributes specific to their rural backgrounds pose unique challenges when such individuals relocate to a new city. Past findings on health‐seeking behaviours among Chinese migrant MSM have only documented disparities in healthcare utilization across local versus transplants . Although many HIV‐related care prevention services for MSM are subsidized by the Chinese government , awareness of these services or their accessibility to clients may be particularly low for rural transplant MSM because of their relevantly lower level of education and sexual health literacy .…”

“…Past findings on health‐seeking behaviours among Chinese migrant MSM have only documented disparities in healthcare utilization across local versus transplants . Although many HIV‐related care prevention services for MSM are subsidized by the Chinese government , awareness of these services or their accessibility to clients may be particularly low for rural transplant MSM because of their relevantly lower level of education and sexual health literacy . Traditional routine interventions on MSM might also face greater barriers in reaching rural transplant MSM who may have more identity struggles or be less likely to take part in health promotion events marketed towards gay men given their experiences of intense stigma directed towards same‐sex behaviours in their rural grow‐up environments .…”

“…Therefore, an individual's registered place and urban/rural classification in his/her hukou is thought to be the proxy for the environment in which one was born and raised. It has been widely used in the existing HIV literature to classify individuals into “migrants” and non‐migrants .…”

“…In many studies on MSM, migration has been particular well examined as an HIV risk factor. Scholars have documented notable trends globally in MSM's migrating from rural area or small cities to larger cities, where the anonymity of city life permits less traditional sexual lifestyles and same sex partners are relatively easier to find . Studies of this type of “sexual migration” have reported associations between transplantation and HIV risk in the form of more sexual partners and riskier sexual practices in the big city .…”

“…While some studies have attributed HIV risk behaviours more common in migrant MSM to them being outsiders (i.e. a transplant) , others have attributed their HIV risk behaviours to them being from disadvantaged rural areas . Discrepancies in definitions of “migrants” or in sampling design further convolute the relationship between migration and HIV risk.…”