Surplus men, sex work, and the spread of HIV in China

Abstract

While 70% of HIV positive individuals live in sub-Saharan Africa, it is widely believed that the future of the epidemic depends on the magnitude of HIV spread in India and China, the world's most populous countries. China's 1.3 billion people are in the midst of significant social transformation, which will impact future sexual disease transmission. Soon approximately 8.5 million 'surplus men', unmarried and disproportionately poor and migrant, will come of age in China's cities and rural areas. Meanwhile, many millions of Chinese sex workers appear to represent a broad range of prices, places, and related HIV risk behaviors. Using demographic and behavioral data, this paper describes the combined effect of sexual practices, sex work, and a true male surplus on HIV transmission. Alongside a rapid increase in sexually transmitted disease incidence across developed parts of urban China, surplus men could become a significant new HIV risk group. The anticipated high sexual risk among many surplus men and injecting drug use use among a subgroup of surplus men may create bridging populations from high to low risk individuals. Prevention strategies that emphasize traditional measures--condom promotion, sex education, medical training--must be reinforced by strategies which acknowledge surplus men and sex workers. Reform within female sex worker mandatory re-education centers and site specific interventions at construction sites, military areas, or unemployment centers may hold promise in curbing HIV/sexually transmitted infections. From a sociological perspective, we believe that surplus men and sex workers will have a profound effect on the future of HIV spread in China and on the success or failure of future interventions.

Abnormal sex ratios in human populations: Causes and consequences

“…Indeed, in China the highest numbers of sex workers are in areas where the sex ratio is least distorted, for example in the border areas of Yunnan Province (57). The recent rise in numbers of sex workers in China has been attributed more to greater mobility, increased socioeconomic inequality, and a relaxation in sexual attitudes, than to an increase in the sex ratio (57,58).…”

Behavioral Studies of Female Sex Workers in China: A Literature Review and Recommendation for Future Research

“…Overall, sexually transmitted cases have increased from 7.2% in 2002 to 43.6% in total infections by the end of 2005 (China Ministry of Health, UNAIDS, and WHO 2006). Public health experts have warned that sex workers and their clients may serve as the ''bridge'' populations linking high risk groups (such as drug users and STD patients) to the general population (Hesketh et al 2005;Tucker et al 2005;Yang et al 2005a).…”

Masculine sex ratios, population age structure and the potential spread of HIV in China

“…Various scenarios of social dislocations as a consequence of an oversupply of men have been described. Dominant among these is the suggestion that a deficit of female partners will contribute to men's social isolation, drive them to adopt high-risk sexual behaviors such as patronage of commercial sex, or to seek their partners among increasingly younger pools of women (Tucker et al 2005;Hudson and den Boer 2004;Hesketh and Zhu 2006). Economic models of marriage and prostitution also posit a link between surplus males and a market for commercial sex.…”

“…Sex differences in migration are an additional demographic factor responsible for altering the market for sexual partners and produce male surpluses in the sexual partnership market in migration destination communities. For example, the disproportionately masculine flows of labor migration from the countryside into cities and towns which have taken place over the last three decades in China (Liang and Ma 2004) are expected to exacerbate the dearth of female partners for male migrants in urban areas (but, by the same token, they might relax the partnership market in the sending rural areas), lead male migrants to adopt HIV-related risk behaviors, such as multiple partnerships and patronage of commercial sex (Tucker et al 2005;Li et al 2004), injecting drug use (Yang, Derlega, and Luo 2005), and increase their vulnerability to STD infection (Li et al 2004;Yang 2005). In fact, China's masculine migration flows and sex ratios at birth are often combined in the same narrative of surplus males even though the precise relationship between sex ratios at birth and internal migration is not discussed (Tucker et al 2005).…”

“…For example, the disproportionately masculine flows of labor migration from the countryside into cities and towns which have taken place over the last three decades in China (Liang and Ma 2004) are expected to exacerbate the dearth of female partners for male migrants in urban areas (but, by the same token, they might relax the partnership market in the sending rural areas), lead male migrants to adopt HIV-related risk behaviors, such as multiple partnerships and patronage of commercial sex (Tucker et al 2005;Li et al 2004), injecting drug use (Yang, Derlega, and Luo 2005), and increase their vulnerability to STD infection (Li et al 2004;Yang 2005). In fact, China's masculine migration flows and sex ratios at birth are often combined in the same narrative of surplus males even though the precise relationship between sex ratios at birth and internal migration is not discussed (Tucker et al 2005). While in other work (Merli et al 2009) we have addressed the role of migration in altering the urban and rural partnership markets and driving up the prevalence of risky sexual behaviors with implications for the spread of HIV/AIDS, in the present paper our treatment of migration is limited to its incorporation into the simulation model to preserve demographic realism.…”