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.
From the aInfectious Disease Center at the University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
bDepartment of Sociology, Tsinghua University, Beijing, China
cInstitute for Sexuality and Gender Research, People's University, Beijing, China
dDepartment of Sociology, University of Chicago, Chicago, Illinois, USA
eChina National STI Control Center, Nanjing, China, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
Received 21 August, 2004
Revised 28 December, 2004
Accepted 13 January, 2005
Correspondence to J. Tucker, National Center for AIDS/STD Control and Prevention, China CDC, Room 510, No. 4 Nanwei Road, Xuanwu District, Beijing, 100050 PRC. E-mail: Joseph_Tucker@med.unc.edu