Hong Y, Stanton B, Li X, Yang H, Lin D, Fang X, Wang J, Mao R. Rural-to-Urban Migrants and the HIV Epidemic in China. AIDS Behav. 2006 Jul;10(4):421-30.
To explore the social, economic, and health implications of rural-to-urban migration in China and their implications for the HIV epidemic.
Qualitative research study involving semi-structured and open-ended interviews with 90 rural-to-urban migrants in two major Chinese cities.
Beijing, the capital city of China, with a population of 13.8 million, and Nanjing, in eastern China. These two cities are among those regions reporting the highest incidence of sexually transmitted diseases (STDs), and together have almost four million rural-to-urban migrants.
A convenience sample of 90 participants was recruited from work and job-market sites, and homes. Local community leaders in migrant settlements facilitated the recruitment process. Participants ranged in age from 16 to 37 years, with the majority (80/90) between 20-29 years of age. Half (44/90) were male; 69/90 were single. More than half (53/90) had first migrated when they were <20 years old. The duration of their stay in Beijing or Nanjing varied from one to >11 years.
Subjects participated in one-time in-depth open-ended interviews. A semi-structured interview guide was developed based on informal discussions with key informants. The following topics were covered: (1) demographic information; (2) reasons for migration; (3) life in the city, including working and living conditions; experience of seeking employment, and interactions with urban residents; (4) sexual attitudes and behaviors; and (5) general awareness and attitudes toward HIV and STDs. Interviews were audio-taped, transcribed and 60/90 were translated into English. Themes, codebooks, and models of relationships were constructed. All Chinese transcripts were also evaluated using word processing software.
The authors identified five major themes. (1) Migrants faced hardship and discrimination adjusting to life in the city, including trouble finding work, mistreatment by employers, crowded living conditions, harassment by police, and difficulty affording and/or acquiring residence and other permits necessary to live and work in the city. (2) Migrants reported changes in sexual norms, such as girlfriends and boyfriends living together, as well as conflicts with traditional Chinese values such as a priority put on the virginity of women in order to marry. (3) Buying and selling sex were frequently reported, though only a small percentage of participants reported they had engaged in these behaviors. (4) Migrants reported fear regarding STDs and HIV, yet misinformation was common and the role of condom use in HIV prevention was poorly understood. Women in particular expressed a lack of control to make decisions to use condoms. (5) Migrants reported strong feelings of rejection and intolerance for persons infected with HIV or other STDs, as well as a sense of denial about the possibility that these diseases might affect their own lives.
The authors conclude that the rural-to-urban migrant population in China faces a large array of risk factors that have multiplied their vulnerability to STDs and HIV.
There is significant potential for heterosexual spread of STDs and HIV among the migrants and their partners in their rural villages of origin. The relatively low HIV prevalence to date has limited the spread of HIV and STDs.
There is no formal rating system for qualitative studies. The main limitation to this qualitative study is the generalizability of the study findings. Participants were selected using convenience sampling. In particular, migrants in larger urban centers might be different from those in smaller cities.
China could be the next frontier for expansion of the global HIV/AIDS epidemic. Between 2002 and 2003, new cases of HIV infection increased by 140%. Although premarital and extramarital sex and prostitution are strongly denounced in traditional Chinese culture, the population is becoming more tolerant of these activities and their prevalence is rapidly increasing. China's large rural-to-urban migrant population (an estimated 9.3% of a total population of 1.3 billion people) was generated by rapid economic development, industrialization and surplus agricultural labor. The large number of migrants may play a crucial role in catalyzing the HIV epidemic in China. Nevertheless, current HIV prevention programs have primarily targeted drug users and commercial sex workers, and few intervention efforts have focused on rural-to-urban migrants.(1,2,3)
Migrant laborers in China urgently need effective HIV prevention programs, including basic information about safe sexual practices, condom use, and HIV and STIs. Migrants are particularly vulnerable because of their displaced status. They are often without residential permits or the ability to access adequate housing and medical care. This also leads to increased risk-taking behavior. Government leadership to support migrants is essential. Social networks based on kinship or region of origin suggest that peer education in rural and as well as urban communities could be especially effective. Further epidemiological research is needed to provide quantitative data on risk behaviors, and to help design intervention strategies.
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- Luo J, Yang F, Li J. Peer education on harm reduction in intravenous drug users in Kunming. Chinese Mental Health Journal 2002;16:112-115. (No abstract available.)
Wu Z, Detels R, Zhang J, Li V, Li J. Community-based trial to prevent drug use among youths in Yunnan, China. Am J Public Health. 2002 Dec;92(12):1952-7.