Prevalence and risks for sexually transmitted infections among a national sample of migrants versus non-migrants in China

The Vulnerability of International Floating Populations to Sexually Transmitted Infections: A Qualitative Study

With the rapid development of the global economy, along with globalisation, the health of international floating populations (especially their sexual health) has become a problem that cannot be ignored. This study explored the potential vulnerability of international floating populations to sexually transmitted infections (STIs) from the points of view of society, religion, culture, migration, community environment, and personal behaviours. In-depth exploratory interviews with 51 members of the international floating population living in China were conducted in June and July 2022. A qualitative thematic analysis methodology was used to analyse the content of these interviews. We found that a conservative culture orientated around religion leads to a lack of sex education, resulting in insufficient personal knowledge as well as a lack of the motivation and awareness required to encourage condom use during sexual contact. Additionally, both geographical isolation and reduced social supervision have expanded personal space, which has led to social isolation and marginalisation, in addition to challenges for coping with STI risk. These factors have increased the possibility of individuals engaging in risky behaviours.

Spatiotemporal analysis of 11 years of Chlamydia trachomatis data from southern China

BACKGROUND

Urogenital Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally. Reviews suggest high and persistently endemic STI epidemics in low and middle income countries. However population-based prevalence estimates in these settings are less common, underscoring the need for analyses of available data to characterize patterns of disease burden. We identified spatio-temporal clusters and key behavioral, social, or environmental factors contribution to transmission in order to inform the prioritization and targeting of evidence based interventions.

METHODS

Using 11 years of data (2006-2016) from the chlamydia case report system of Guangdong, China, we identified county level spatio-temporal hot and cold spots using the Getis-Ord Gi* statistic and discrete Poisson models in SaTScan 9.6. We also estimated associations between observed distribution patterns and area-level demographic, social, and economic factors using quasi-Poisson regression models that controlled for annual counts of certified laboratories to account for fluctuations in location-specific detection capacity.

FINDINGS

Cluster analysis indicates an expanding chlamydia epidemic in Guangdong, with cases clustered in regions of greatest economic activity. Greater male-to-female sex ratio (RR, 3.63; 95% CI, 1.41-9.45) and greater urbanicity (RR, 2.44; 95% CI, 1.98-2.99) were predictive of higher chlamydia case occurrence.

INTERPRETATION

We found that chlamydia case occurrence in Guangdong province has been accelerating over the past 11 years and that its expansion is tied to indicators of social and economic development. These estimates not only identify high prevalence regions to target but also areas where data gaps potentially remain. The salience of sex ratios and urbanicity may best be understood through the lens of China's modern history of labor migration which has reshaped the gender dynamics and health access landscape of urban China. Future chlamydia control efforts will require a population-based approach focused on reengaging sexually active adults of diverse economic and migratory backgrounds.

FUNDING

This was an unfunded study using routinely collected public health data.

Health education services utilization and its determinants among migrants: a cross-sectional study in urban-rural fringe areas of Beijing, China

Background

Domestic migration poses a challenge for China as migrants have little access to preventive healthcare services and are vulnerable to certain risks and diseases. This research sought to unveil and explore the determinant factors associated with health education utilization as a key aspect in basic public health services for migrants in Beijing, China.

Methods

A sample of 863 inter-provincial migrants, 18 years old and above, was selected by three-stage stratified cluster sampling method in urban-rural fringe areas of Beijing during 2016 to 2017. Face-to-face structured interviews were conducted in the questionnaire survey. The effects of the explanatory variables on health education utilization from predisposing, enabling, health behaviors and need variables were used to demonstrate by Anderson health service utilization model.

Results

The study revealed that 61.6% migrants desired to receive health education, while only 53.8% of them received in the past year. There were differences in the utilization and needs of health education among the migrants in different ages and genders. Many migrants desired to gain access to various types of health education information from the internet. Chi-square independence test lists such major determinant factors in migrants whole health education as age, “Hukou” registration system, marital status, education level, long-term residence plan in Beijing, one or more children in Beijing, employment status, housing source, average daily working time, exercises, health knowledge, smoking, self-rated health. The binary logistic regression indicates that the migrants with younger age, high education level, one or more children in Beijing, exercises and good self-rated health were more likely to receive whole health education. The results also show that average daily working time of enabling variables and exercise of health behavior variables were the strong and consistent determinants of three types of health education utilization, including communicable, non-communicable and occupational diseases.

Conclusion

Gaps exist between the needs and utilization in health education and more attention should be given to the migrants with heavy workload and low education level. Feasible policies and measures, such as multiple health information channels, should be vigorously implemented to ensure equitable and easy access to health education for migrants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01368-1.

Sexually transmitted infections' epidemiology and knowledge, attitude and practice survey in a set of migrants attending the sexual health clinic in Malta

BACKGROUND

The number of international migrants is estimated at 272 million people worldwide. In Europe, migrants face the disproportionate burden of infectious diseases, including hepatitis B and C, HIV and sexually transmitted infections (STIs). High-risk behaviours, sexual abuse, poor living conditions and barriers to accessing health care may affect migrants' sexual health, leading to infections.

OBJECTIVES

The study evaluates STIs and HIV prevalence and knowledge, attitude and practice (KAP) in non-European migrants attending the sexual health clinic in Malta. It also seeks to explore situations of human trafficking (HT), sex/gender-based violence (S/GBV) and female genital mutilations (FGM).

METHODS

This is a mixed-method study, based on quantitative and qualitative research within a single centre. An anonymous pretested questionnaire was administered to non-European migrants attending the genitourinary clinic (GUC) with the assistance of an ethnocultural agent. Demographics, STI diagnoses and risk behaviours were collected from the GUC database, linked to the questionnaires and analysed.

RESULTS

A total of 143 migrants took part in the study, 73% were young male and 16.7% men who have sex with men (MSM). Forty-one different nationalities were recorded, and the top ones were Nigerian (12%), Filipino (7.4%) and Chinese (5.4%). Concerning risk behaviours, 33.8% of respondents had never used a condom and 76.5% had had sex with multiple partners in the 6 months prior to the study. STI prevalence was 73.1%. Of the patients interviewed, six females were Chinese sex workers employed in massage parlours, potentially trafficked to Malta.

CONCLUSIONS

The study outcomes support the need of improving awareness about STIs/HIV risk and testing. In migrants at particular risk for HIV, combination prevention strategies should include access to pre-exposure prophylaxis and antiretrovirals independently from migrants' legal status. Finally, STIs/HIV prevention in migrants should be linked with interventions tackling HT and other forms of S/GBV.

Prevalence of co-infections with other sexually transmitted infections in patients newly diagnosed with anogenital warts in Guangzhou, China

Prevalence of co-infecting sexually transmitted infections (STIs) among patients newly diagnosed with anogenital warts is under-reported. Our objective is to determine the prevalence of six common STIs, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), genital herpes (herpes simplex virus type 2 [HSV-2]), HIV, and syphilis for patients visiting a sexual health clinic in Guangzhou, China. Demographics, sexual health, and medical histories were collected at patient intake. Patients diagnosed with anogenital warts (N = 200) were invited to participate. We collected urine samples, and urethral, cervical, and rectal swabs to test for CT, NG, and MG, and blood samples for serological detection of HSV-2, syphilis, and HIV. Overall 49 (24.5%) had a co-infection (22.2% of men and 27.7% of women). All six STIs were observed among men: CT (6.8%), NG (3.4%), MG (5.1%), HIV (4.3%), HSV-2 (4.3%), and syphilis (1.7%). Women had fewer STIs, but at higher rates: CT (13.3%), MG (6.0%), and HSV-2 (8.4%). Individual men had up to two co-infections, while women had no more than one co-infection. Chlamydia was the most common STI. Patients aged 18-25 years (35.4%) had the highest prevalence. Although opportunistic screening is often applied for high-risk groups, expansion to patients with anogenital warts in all health-care settings would improve detection of problematic asymptomatic co-infections, thereby increasing China's capacity to contribute toward global surveillance systems.

Prevalence, risk factors, and medical costs of Chlamydia trachomatis infections in Shandong Province, China: a population-based, cross-sectional study

Background

A population-based study of Chlamydia trachomatis (CT) infections is essential in designing a specific control program; however, no large investigation of CT infections among the general population in mainland China has been conducted since 2000. We aimed to determine the prevalence, risk factors, and associated medical costs of CT among residents, 18–49 years of age, in Shandong, China.

Methods

From May to August 2016, a multistage probability sampling survey involving 8074 individuals was distributed. Data were collected via face-to-face interviews, followed by self-administered questionnaire surveys. First-void urines were collected and tested for CT and Neisseria gonorrhoeae (NG) using nucleic acid amplification.

Results

The weighted prevalence of CT infection was 2.3% (95% confidence interval [CI], 1.5–3.2) in females and 2.7% (1.6–3.8) in males. Women, 30–34 years of age, had the highest prevalence of CT infections (3.5%, 2.6–4.4), while the highest prevalence of CT infections in males was in those 18–24 years of age (4.3%, 0.0–8.8). Neisseria gonorrhoeae infection had a prevalence of 0.1% (0.0–0.3) in women and 0.03% (0.0–0.1) in men. Risk factors for CT infections among females included being unmarried, divorced, or widowed (odds ratio [OR], 95% CI 3.57, 1.54–8.24) and having two or more lifetime sex partners (3.72, 1.14–12.16). Among males, first intercourse before 20 years of age (1.83, 1.10–3.02) and having two or more lifetime sex partners (1.85, 1.14–3.02) were associated with CT infections. The estimated lifetime cost of CT infections in patients 18–49 years of age in Shandong was 273 million (range, 172–374 million) China Renminbi in 2016.

Conclusions

This study demonstrated a high burden of CT infections among females < 35 years of age and males < 25 years of age in Shandong. Thus, a CT infection control program should focus on this population, as well as others with identified risk factors.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3432-y) contains supplementary material, which is available to authorized users.

Spatiotemporal distribution and determinants of gonorrhea infections in mainland China: a panel data analysis

OBJECTIVES

Gonorrhea remains a major public health concern worldwide. This study aims to explore the spatiotemporal distribution and sociodemographic determinants of gonorrhea rates during 2004-2014 in mainland China.

STUDY DESIGN

Space-time scan statistics and spatial panel regression model.

METHODS

The gonorrhea infection data and sociodemographic data during 2004-2014 at the provincial level in mainland China were extracted from the China Public Health Science Data Center and China Statistical Yearbooks, respectively. The space-time scan statistics were used to identify the high-risk clusters of gonorrhea, and the spatial panel regression model was adopted to examine the sociodemographic determinants.

RESULTS

One most likely and five secondary high-risk clusters of gonorrhea rates were identified, which were mainly located in southern and eastern China. The regions with higher GDP per capita, larger floating population, less access to healthcare, higher male-female ratio, and higher divorce rate were more likely to become high-risk areas of gonorrhea.

CONCLUSIONS

Gonorrhea rates were distributed unevenly through space and time and affected by various sociodemographic variables. The space-time scan statistics and spatial panel regression are viable tools for identifying clusters and examining determinants of gonorrhea rates. The findings provide valuable implications for developing targeted prevention and control programs in public health practice.

HIV testing and sexual risks among migrant men who have sex with men: findings from a large cross-sectional study in Beijing, China

Despite the exacerbating HIV transmission among migrant men who have sex with men (MSM) in China, few epidemiological studies explore their HIV testing/risk profiles. We sought to explore sociodemographic/behavioral correlates of HIV/syphilis and HIV testing among migrant MSM. A study was conducted among 3,588 HIV-uninfected MSM. Participants were recruited via short message services, peer referral, web-advertisement and community outreach. HIV/syphilis infections were lab-confirmed. Migrant MSM were more likely to be HIV-infected compared to local MSM. Among 2,699 migrant MSM, HIV testing was associated with older age, living longer in Beijing, having ≥10 lifetime male sexual partners (LMSPs), having insertive anal sex; while being unemployed/retired and having condomless receptive anal sex (CRAS) were associated with a lower odds of HIV testing. Being married, living longer in Beijing, ever testing for HIV and having sex with women were associated with lower HIV odds; while being unemployed/retired, having higher HIV perception, having ≥ 10 LMSPs and having CRAS were associated a higher HIV odds. Increased likelihood of syphilis was associated with older age, being employed, higher HIV perception, having ≥10 LMSPs and having CRAS. Our study provides implications for targeted interventions to tackle HIV/STI risks and improve HIV testing among migrant Chinese MSM.

Changing Epidemic of HIV and Syphilis Among Resident and Migrant Men Who Have Sex with Men in Jiangsu, China

Men who have sex with men (MSM) in China face high rates of HIV and syphilis infection exacerbated by internal migration. Studies on the differences of HIV and syphilis epidemics changing trends in high-risk behaviors and geographic distribution between resident and migrant MSM in Jiangsu, China were conducted. MSM were recruited from 14 surveillance sites in the serial cross-sectional study. Data on demographics, sexual behaviors, HIV and syphilis prevalence were collected. Participants were classified as residents or migrants based on household registration. During 2010–2014, 19,750 MSM were investigated. Engaged in anal sex (76.3% to 80.2%, P < 0.01) as well as received HIV-related services (72.1% to 79.2%, P < 0.01) were increasing. In contrast, engaged in commercial anal sex with males (7.4% to 5.0%, P < 0.01) and drug use (1.6% to 0.8%, P < 0.01) were decreasing. HIV prevalence ranged between 8.6% to 9.6%, while syphilis prevalence decreased over time (13.4–6.8%, P < 0.01). Further, we found that migrant MSM were more likely to engage in condomless anal sex, also had a higher HIV and syphilis prevalence than resident. During the study period, while syphilis prevalence decreased, higher rates of risk behaviors among migrant MSM called for targeted intervention strategies to reduce the HIV transmission.

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

Background

Migrant 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.

Methods

A 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.

Results

The 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).

Conclusions

Prevalence 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.

HIV/STIs risks between migrant MSM and local MSM: a cross-sectional comparison study in China

Background. Internal migration plays a significant role in China’s HIV epidemic. However, few studies have directly compared migrant men who have sex with men (MSM) with local MSM with regard to HIV/sexually transmitted infections (STIs) risks.

Methods. We conducted a study in Guangzhou, China, with the aim of understanding the differences in HIV/STIs risks between migrant MSM and local MSM. A cross-sectional study was conducted among 273 migrant MSM and 249 local MSM in Guangzhou, China. Their behavioral and serologic data on HIV/syphilis were collected and compared between the two groups. A multivariate logistic regression was used to estimate the associations between HIV/STIs risks and migratory status.

Results. Migrant MSM, compared to local MSM, have higher odds of reporting unprotected anal intercourse (UAI) (OR = 1.4; 95% CI [0.9–2.0]) and having multiple homosexual partners (OR = 1.2; 95% CI [0.8–1.8]). A lower rate of condom use at homosexual debut was reported in migrant MSM than in local MSM (OR = 0.7; 95% CI [0.5–0.9]). Migrant MSM have less odds of reporting HIV/STIs testing in the previous 6 months relative to local MSM (OR = 0.5; 95% CI [0.4–0.8]). In addition, migrant MSM demonstrated a lower level of HIV knowledge than local MSM (OR = 0.4; 95% CI [0.2–0.8]).

Conclusion. Migrant MSM are more likely to engage in sexual risk behaviors, report a lower level of HIV knowledge and have less access to HIV/STIs testing. Further comprehensive interventions targeting migrant MSM are urged.

The Silk Road Health Project: How Mobility and Migration Status Influence HIV Risks among Male Migrant Workers in Central Asia

OBJECTIVES

We examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex).

METHODS

We used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics.

RESULTS

Mobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants.

CONCLUSION

Study findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population.

Spatial distribution and cluster analysis of risky sexual behaviours and STDs reported by Chinese adults in Guangzhou, China: a representative population-based study

OBJECTIVES

To assess associations between residences location, risky sexual behaviours and sexually transmitted diseases (STDs) among adults living in Guangzhou, China.

METHODS

Data were obtained from 751 Chinese adults aged 18-59 years in Guangzhou, China, using stratified random sampling by using spatial epidemiological methods. Face-to-face household interviews were conducted to collect self-report data on risky sexual behaviours and diagnosed STDs. Kulldorff's spatial scan statistic was implemented to identify and detect spatial distribution and clusters of risky sexual behaviours and STDs. The presence and location of statistically significant clusters were mapped in the study areas using ArcGIS software.

RESULTS

The prevalence of self-reported risky sexual behaviours was between 5.1% and 50.0%. The self-reported lifetime prevalence of diagnosed STDs was 7.06%. Anal intercourse clustered in an area located along the border within the rural-urban continuum (p=0.001). High rate clusters for alcohol or other drugs using before sex (p=0.008) and migrants who lived in Guangzhou <1 year (p=0.007) overlapped this cluster. Excess cases for unprotected sex (p=0.031) overlapped the cluster for college students (p<0.001). Five of nine (55.6%) students who had sexual experience during the last 12 months located in the cluster of unprotected sex.

CONCLUSIONS

Short-term migrants and college students reported greater risky sexual behaviours. Programmes to increase safer sex within these communities to reduce the risk of STDs are warranted in Guangzhou. Spatial analysis identified geographical clusters of risky sexual behaviours, which is critical for optimising surveillance and targeting control measures for these locations in the future.

An evaluation of the buffering effects of types and sources of support on depressive symptoms among natural disaster exposed Chinese adults

OBJECTIVE

Social support is a key protective factor for people exposed to natural disasters. The effect of type and source of this support is not well documented. Investigations are needed to identify the specific modifying role of received and perceived support from family and friends on the association between disaster exposure and depressive symptoms.

METHODS

Face-to-face household interviews were conducted in 2014 with a random sample of 751 adults recruited from Yuexiu and Tianhe districts in Guangzhou, China. Sampling was accomplished through spatial epidemiological methods. Participants' exposure to disaster, depressive symptoms, and social support networks was recorded on tablet devices. Multiple regression analysis was used to test the potential moderating role of social support on depression symptoms.

RESULTS

A total of 30.24% reported natural disaster exposure. Disaster exposure and received family support were significantly and positively related to depressive symptoms. In contrast, perceived family support moderated the relationship between disaster exposure and depressive symptoms. No association was found between support from friends and depressive severity.

CONCLUSION

Perceived family support buffered the effect of disaster exposure in this sample, while received family support was associated with increased depression. Perceived family support is an important resource among those who experience disaster exposure and actual provision of family support may be harmful or miscarried. Natural disasters are becoming increasingly prevalent in Asia. According to the Economic and Social Commission for Asia and the Pacific (ESCAP, 2015a), a total of 119 disaster events, accounting for more than half of the total number of disasters occurred in the world, took place in Asia in 2014, affecting 79.6 million people, among whom 6050 died. The Chinese Mainland experienced several major natural disasters, including the earthquake in Wechuan, Sichuan Province, in 2008 and natural disasters affected more than 500,000 people causing 0.4% of GDP loss (roughly US$3 trillion; ESCAP, 2015b). The current study investigated the effect of social resources on mental health following natural disaster exposure.

Sexual behavior of migrant workers in Shanghai, China

BACKGROUND

Rapid urbanization of China has resulted in significant domestic migration. The purpose of the present study was to survey the sexual behavior of migrant workers in Shanghai and determine the risk factors for unprotected sex.

METHODS

A cross-sectional study of the sexual behavior of 5996 migrant workers was conducted in 7 administrative regions of Shanghai in 2012 from August to October. A self-administered questionnaire was used to collect data.

RESULTS

Five thousand seven hundred seventy two out of the 5996 migrants enrolled into the present study were primarily young adults aged 34.3 ± 10.6 years. Of them, 73.5 % were married, 51.1 % graduated from junior high school, 46.0 % earned 1500-2500 yuan (RMB) monthly. The majority (82.3 %) of the migrants engaged in sexual behavior, and 58.0 % did not use condoms in sexual intercourse. Some of the participants (15.2 %) had casual extramarital partners within the previous 12 months; among them, 76.2 % never or only occasionally used condoms. The results of the multivariate logistic regression analysis suggested that condom use was associated with age, occupation, monthly income, education, and housing conditions. Having temporary sexual partners was significantly associated with several factors such as unmarried (OR: 0.47, 95 % CI: 0.38-0.57), working at domestic (OR: 1.65,95 % CI: 1.17-2.34), working at wholesale/retail(OR: 1.65, 95 % CI: 1.13-2.13), and male migrants (OR: 2.37, 95 % CI: 1.96-2.85), but not with other factors such as age, monthly income, or education. Having casual extramarital partners was significantly associated with female migrants working at domestic (OR: 1.89, 95 % CI: 1.09-3.28), unmarried male migrants (OR: 0.51, 95 % CI: 0.36-0.74).

CONCLUSION

Closer attention should be paid to sexual health education among migrant workers, especially women and those working in domestic and wholesale/retail occupations. The use of condoms should be promoted for older (>35 y), low-income, and less-educated individuals.

Rural-to-urban migrants are at high risk of sexually transmitted and viral hepatitis infections in China: a systematic review and meta-analysis

Background

Rapid economic development in urban China has led to a mass migration of surplus rural residents into urban areas for better employment opportunities. This study aims to identify prevalence levels and risks of sexually transmitted infections (STIs) and hepatitis among the rural-to-urban migrant population in China.

Methods

Chinese and English literature databases were searched for studies reporting prevalence of HIV, STIs and viral hepatitis among rural-to-urban migrants in China between 1990 and 2013. The estimates were summarised through a systematic review and meta-analysis. The risks of infection were compared between migrants and the general Chinese population.

Results

We identified a total of 411 eligible studies. The prevalence of HIV, syphilis, gonorrhea, genital warts and HCV among migrants were 0.23% (0.20-0.27%), 0.69% (0.57-0.84%), 2.18% (1.30-3.64%), 1.54% (0.70-3.36%) and 0.45% (0.31-3.65%), representing 4.0 (3.1-5.2), 1.9 (1.1-3.0), 13.6 (5.8-32.1), 38.5 (15.7-94.5) and 3.8 (1.9-7.3) higher odds of infection than among the general population. Construction workers, long-distance truck drivers and migrant women through marriage were migrant subgroups that were highly susceptible to STIs and hepatitis. HIV prevalence among migrant pregnant women (0.10%, 0.02-0.49%) was significantly higher than that of pregnant women in the general Chinese population (OR = 7.7, 3.4-17.4). However, no significant differences were observed in STIs and hepatitis between overall female sex workers (FSWs), men who have sex with men (MSM) and drug users (DUs), and the corresponding subgroups with a migratory background.

Conclusions

Rural-to-urban migrants have a higher risk of STIs and hepatitis than the general Chinese population, but a migratory background does not increase the infection risks of STIs and hepatitis in FSWs, MSM and DUs.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-490) contains supplementary material, which is available to authorized users.

Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis

Background

Sexually transmitted infections (STIs), including Hepatitis B and C virus, are emerging public health risks in China, especially among men who have sex with men (MSM). This study aims to assess the magnitude and risks of STIs among Chinese MSM.

Methods

Chinese and English peer-reviewed articles were searched in five electronic databases from January 2000 to February 2013. Pooled prevalence estimates for each STI infection were calculated using meta-analysis. Infection risks of STIs in MSM, HIV-positive MSM and male sex workers (MSW) were obtained. This review followed the PRISMA guidelines and was registered in PROSPERO.

Results

Eighty-eight articles (11 in English and 77 in Chinese) investigating 35,203 MSM in 28 provinces were included in this review. The prevalence levels of STIs among MSM were 6.3% (95% CI: 3.5–11.0%) for chlamydia, 1.5% (0.7–2.9%) for genital wart, 1.9% (1.3–2.7%) for gonorrhoea, 8.9% (7.8–10.2%) for hepatitis B (HBV), 1.2% (1.0–1.6%) for hepatitis C (HCV), 66.3% (57.4–74.1%) for human papillomavirus (HPV), 10.6% (6.2–17.6%) for herpes simplex virus (HSV-2) and 4.3% (3.2–5.8%) for Ureaplasma urealyticum. HIV-positive MSM have consistently higher odds of all these infections than the broader MSM population. As a subgroup of MSM, MSW were 2.5 (1.4–4.7), 5.7 (2.7–12.3), and 2.2 (1.4–3.7) times more likely to be infected with chlamydia, gonorrhoea and HCV than the broader MSM population, respectively.

Conclusion

Prevalence levels of STIs among MSW were significantly higher than the broader MSM population. Co-infection of HIV and STIs were prevalent among Chinese MSM. Integration of HIV and STIs healthcare and surveillance systems is essential in providing effective HIV/STIs preventive measures and treatments.

Trial Registration

PROSPERO No: CRD42013003721

Networking activities and perceptions of HIV risk among male migrant market vendors in China

HIV research among internal migrants in China has not fully explored the contexts and perceptions of "risk". In 2011, urban markets in Liuzhou, China were mapped, and sixty male vendors, age 22-56, were selected for in-depth interviews on migration, social and family life, and perceptions and practices of sexual risk behavior. Participants were evenly divided among higher income shop and small stall vendors. All men were sexually active. Only the shop vendors reported non-marital sexual partners, including concurrent partners (n = 15), commercial partners (n = 10), and other sexual relationships (n = 11). Shop vendors engaged in networking activities that facilitated commercial and non-commercial high-risk sex. Perceptions of HIV risk from commercial sex led some men to doubt the protective ability of condoms and rely on local (unproven) self-protection techniques. Networking activities played a role in high-risk sex and shaping migrants' risk perceptions and health practices. The networks created through these processes could also be used to facilitate health promotion activities.

Rural-urban migration and mental and sexual health: a case study in Southwestern China

Massive rural–urban temporary migration has taken place amid China's rapid economic growth and development. Much has been written about the economic causes and consequences of this massive migration; less studied are the potential health and behavioral impacts of migration on migrants. Using data from a population-based sample survey conducted in southwestern China, this paper examines the potential impact of rural–urban migration and post-migration urban living on migrants' mental health and sexual risk behavior. The results suggest that regardless of places of origin and destination temporary migrants had on average poorer mental health and riskier sexual behavior than non-migrants. Compared to living in rural areas, living in urban areas does not make statistical difference in residents' mental health; it is only marginally associated with riskier sexual behavior. Rural–urban temporary migrants' mental health and health risk sexual behavior deserve more immediate research attention. Both selectivity of temporary migrants and migration-induced psycho-socio-behavioral changes may have contributed to migrants' poorer mental health and riskier sexual behavior. However, more theory-driven research with longitudinal design is needed before firm conclusions can be drawn about the underlying mechanisms that mediate or moderate the impact of temporary migration on migrants' mental health and sexual risk behavior.

Risk factors for male patients with gonorrhoea complicated by inflammation of the paraurethral glands around the external urethral orifice

Gonococcal inflammation of paraurethral glands around the external urethral orifice is a local complication of gonorrhoea in men. To investigate the risk factors for this complication we compared prepuce factors, Chlamydia trachomatis infection, demographic data and behavioural indicators of gonorrhoeal patients with and without this complication. Results showed that a prolonged disease course of gonorrhoea, sexual intercourse during gonorrhoea, repeated squeezing of the penis and a redundant prepuce were risk factors for this complication.

Health of China's rural-urban migrants and their families: a review of literature from 2000 to 2012

BACKGROUND

Socioeconomic transformation in China at the beginning of the twenty-first century has led to rapid urbanization and accelerated rural-urban migration. As a result, the concerns about public health problems triggered by increasing internal population mobility have been more widely studied in recent years.

SOURCES OF DATA

Published data in Chinese and English on health of migrants and their families in mainland China from 2000 to 2012.

AREAS OF AGREEMENT

The shifting patterns of disease distribution due to rural-urban migration, health equity and health reform strategies that cater for this specific yet substantial subpopulation are outstanding concerns. Infectious diseases, mental health, occupational health and women's health are emerging public health priorities related to migration.

AREAS OF CONTROVERSY

The high mobility and large numbers of Chinese rural-urban migrants pose challenges to research methods and the reliability of evidence gained.

GROWING POINTS

While the theme of working migrants is common in the literature, there have also been some studies of health of those left behind but who often remain unregistered. Migration within China is not a single entity and understanding the dynamics of new and emerging societies will need further study.

AREAS TIMELY FOR DEVELOPING RESEARCH

Social, economic, emotional, environmental and behavioural risk factors that impact on health of migrants and their families call for more attention from health policy-makers and researchers in contemporary China.

Demographic and behavioral determinants of self-reported history of sexually-transmitted diseases (STDs) among young migrant men who have sex with men (MSM) in Beijing, China

BACKGROUND

Sexually-transmitted disease (STD) is a facilitating cofactor that contributes to human immunodeficiency virus (HIV) transmission. Previous studies indicated a high prevalence of STDs among men who have sex with men (MSM) in China. To date, limited data are available for correlates of STD infection among young migrant MSM in China. The current study intends to examine the association between demographic and behavioral factors and STD infection.

METHODS

Data were collected from a sample of 307 migrant MSM aged 18-29 years in Beijing in 2009. Multivariate logistic regression analysis was employed to examine the factors associated with a history of STDs.

RESULTS

Results showed that about 13% of MSM reported a history of STDs. The average number of lifetime sexual partners was 15.0. About 56.7% of MSM did not use a condom at the first sexual encounter. The percentage of MSM who used a condom consistently was 47.4%. Multivariate logistic regression results showed that STD history was positively associated with education, income, the number of lifetime male sexual partners, and negatively associated with the frequency of properly using a condom.

CONCLUSION

STD history was associated with socioeconomic status and sexual risk behaviors. The results suggested that HIV prevention intervention programs need to educate MSM to reduce the number of sexual partners and to use a condom properly. Furthermore, HIV prevention intervention programs among MSM need to be tailored to meet the needs of different socioeconomic groups of MSM.

Sexual attitudes, behaviours and acculturation among young migrants in Shanghai

China's rates of internal migration increased to an all-time high of over 200 million individuals at the beginning of the twenty-first century. Yet, there is a dearth of information on the lives of young migrant populations. The aim of this study was to explore how migration influences the sexual attitudes and behaviours of 18-24-year-old migrant men and women in Shanghai, China. A total of 64 migrants participated in 10 focus-group discussions and 20 in-depth interviews. Guided by acculturation theory, coded data were organised into analytic matrices to compare themes across participants. Factors associated with increased sexual-risk behaviours include acculturative stress, discrimination leading to social isolation, conflicts between traditional and modern city values and increased sexual opportunities. Premarital sex, cohabitation, unprotected sex and visiting sex workers are common among this population. Reasons for not using condoms included being unprepared, lack of knowledge and barriers in accessing reproductive services due to not having urban documentation. Local family planning programmes should help migrants negotiate traditional and modern values and partner with work-sites to provide comprehensive sexual education and services and train health professionals in the specific healthcare needs of young migrant populations.

HIV and STI prevalence and determinants among male migrant workers in India

BACKGROUND

Our objective was to estimate for the first time the prevalence and determinants of human immunodeficiency virus type 1 (HIV-1) and sexually transmitted infections (STIs) among male migrants in India.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted a multi-stage stratified probability sample survey of migrant (defined as not born in Surat city) men aged 18 to 49 years working in the diamond and textile industries in Surat city. Behavioural and biological data were collected. Biological data included laboratory diagnosed herpes simplex virus type 2 (HSV-2), syphilis, chlamydia, gonorrhoea, Trichomonas vaginalis (together defined as 'any STI') and HIV-1. Likely recently acquired STIs included chlamydia, gonorrhoea, T. vaginalis and syphilis with rapid plasma reagin ≥1:8. The response rate was 77% (845/1099). Among 841 participants, HIV-1 prevalence was 1.0%, 'any STI' prevalence was 9.5% and 38.9% of these STIs were likely to have been recently acquired. Being a diamond worker, Surat resident for 10+ years and recent antibiotic use were each associated with higher odds of 'any STI' (aORs 1.83 (95% CI 1.09-3.09), 1.98 (95% CI 1.22-3.22) and 2.57 (95% CI 1 .17-5.64), respectively) after adjusting for the other two factors and age. The main study limitation was social desirability bias for self-reported sexual behaviour; STIs were diagnosed in some self-reported virgins.

CONCLUSIONS/SIGNIFICANCE

HIV and STI prevalence were lower than expected, but prevention interventions remain necessary in Surat since almost 40% of STIs among participants were probably recently acquired and sentinel surveillance HIV prevalence remains high. The participants had a similar HIV prevalence to Surat antenatal clinic attendees, a proxy for the general population. This suggests migrants are not always at higher risk of HIV compared to the general population in their migration destination. Our findings highlight the need to contextualise research findings from a specific setting with other local information to guide HIV/STI prevention interventions.

Forced bachelors, migration and HIV transmission risk in the context of China's gender imbalance: a meta-analysis

China has experienced continual increase in the sex ratio at birth (SRB) since the 1980s, which has led to a serious gender imbalance. To identify whether the future forced bachelors, especially those who migrate to cities, will increase the risk of HIV spread, a systematic review was carried out of studies published since 2000 that include the sexual risks of male migrants of China. Five studies comparing risk differences between migrants and non-migrants showed male migrants had greater risk of having multiple sexual partners and engaging in commercial sex. Ten studies concerning the relationship between sexual risks and socio-demographic characteristics showed that unmarried male migrants were more likely to engage in commercial sex and be infected with STDs than married migrants, while male migrants with higher income were more likely to have multiple sexual partners and be infected with STDs. In an analysis stratified by sample characteristics, the association between marriage and sexual risk was greater among samples with lower mean age, higher average income and education. In addition, the risk selection on education and income disappeared in the samples of migrants of whom more than half were unmarried.

Urbanisation and health in China

China has seen the largest human migration in history, and the country's rapid urbanisation has important consequences for public health. A provincial analysis of its urbanisation trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. The growing disease burden in urban areas attributable to nutrition and lifestyle choices is a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China's rural-to-urban migrant population. Urban environmental quality, including air and water pollution, contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorised. To address the health challenges and maximise the benefits that accompany this rapid urbanisation, innovative health policies focused on the needs of migrants and research that could close knowledge gaps on urban population exposures are needed.

A multi-center survey of age of sexual debut and sexual behavior in Chinese women: suggestions for optimal age of human papillomavirus vaccination in China

OBJECTIVE

Cervical cancer is the second most common cancer among women worldwide, and over 85% of cervical cancers occur in developing countries such as China. Lack of resources for nationwide cervical cancer screening in China makes vaccination against oncogenic strains of HPV particularly important. Knowledge of age at sexual debut and sexual behavior is essential prior to implementation of a national vaccination program.

METHODS AND MATERIALS

A cross-sectional epidemiologic survey was conducted across 21 urban and rural sites in China to assess age at sexual debut and sexual behavior. 98.6% of the 11,852 recruited women aged 15-59 years were included in the analysis. Data were collected using a short, nurse-administered questionnaire and analyzed using standard descriptive statistics and survival analysis.

RESULTS

In urban areas, more than ten percent of the 15-19 year old age group were already sexually active at the time of interview; this number increased to nearly 44% in the 20-24 year old age group. Chinese young women with an occupation were more likely to be sexually active compared to female students of the same age, irrespective of area of residence. The crude median sexual debut age for the youngest age group was 17 years, earlier than the sexual debut age reported by older cohorts. Younger age cohorts had an earlier menarche age than older cohorts and were more likely to have more sexual partners than older women, and more likely to have partners with more than one female partner.

CONCLUSION

There is a trend towards earlier sexual debut and riskier sexual behaviors in younger age groups of Chinese women. These findings suggest that HPV vaccination of women between the ages of 13 and 15 years, before the completion of national compulsory education, is likely to contribute to the prevention of HPV infection and cervical cancer in China.

Male migration and risky sexual behavior in rural India: is the place of origin critical for HIV prevention programs?

Background

Recent studies of male migrants in India indicate that those who are infected with HIV are spreading the epidemic from high risk populations in high prevalence areas to populations in low prevalence areas. In this context, migrant men are believed to initiate and have risky sexual behaviors in places of destination and not in places of origin. The paucity of information on men's risky sexual behaviors in places of origin limits the decision to initiate HIV prevention interventions among populations in high out-migration areas in India.

Methods

A cross-sectional behavioral survey was conducted among non-migrants, returned migrants (with a history of migration), and active (current) migrants in rural areas across two districts with high levels of male out-migration: Prakasam district in Andhra Pradesh and Azamgarh district in Uttar Pradesh. Surveys assessed participant demographics, migration status, migration history, and sexual behavior along the migration routes, place of initiation of sex. District-stratified regression models were used to understand the associations between migration and risky sexual behaviors (number of partners, condom use at last sex) and descriptive analyses of migrants' place of sexual initiation and continuation along migration routes.

Results

The average age at migration of our study sample was 19 years. Adjusted regression analyses revealed that active migrants were more likely to engage in sex with sex workers in the past 12 months (Prakasam: 15 percent vs. 8 percent; adjusted odds ratio (aOR)=2.1, 95% CI 1.2-3.4; Azamgarh: 19 percent vs.7 percent; aOR=4.0, 95% CI 2.4-6.6) as well as have multiple (3+) sex partners (Prakasam: 18 percent vs. 9 percent; aOR=2.0, 95% CI 1.3-3.2; Azamgarh: 28 percent vs. 21 percent; aOR=1.9, 95% CI 1.2-3.0) than non-migrants. Contrary to popular belief, a high proportion of active and returned migrants (almost 75 percent of those who had sex) initiated sex at the place of origin before migrating, which is equivalent to the proportion of non-migrants who engaged in sex with sex workers as well as with casual unpaid partners. Moreover, non-migrants were more likely than migrants to engage in unprotected sex.

Conclusion

Findings of this study document that returned migrants and active migrants have higher sexual risk behaviors than the non-migrants. Most migrants initiate non-marital sex in the place of origin and many continue these behaviors in places of destination. Migrants’ destination area behaviors are linked to sex with sex workers and they continue to practice such behaviors in the place of origin as well. Unprotected sex in places of destination with high HIV prevalence settings poses a risk of transmission from high risk population groups to migrants, and in turn to their married and other sexual partners in places of origin. These findings suggest the need for controlling the spread of HIV among both men and women resulting from unsafe sex in places of origin that have high vulnerability due to the frequent migratory nature of populations.

The epidemic of sexually transmitted infections in China: implications for control and future perspectives

China has experienced an increasing epidemic of sexually transmitted infections (STIs), including HIV. High risk groups likely to be infected include female sex workers (FSWs) and their clients, men who have sex with men (MSM), drug users and migrant workers. Prevention can be achieved through education of the population, condom promotion, early detection of symptomatic and asymptomatic people, and effective diagnosis and treatment of these patients and their partners. This article aims to describe the profile of the epidemic in high-risk groups in China as well as to detail the contributing factors and the implications for control. Programmes for the control of STIs should be immediate priorities in China, and primary and secondary prevention strategies are vital to this process.

Unsafe Abortion as a Birth Control Method

Reproductive health research and policies in Cambodia focus on safe motherhood programs particularly for married women, ignoring comprehensive fertility regulation programs for unmarried migrant women of reproductive age. Maternal mortality risks arising due to unsafe abortion methods practiced by unmarried Cambodian women, across the Thai-Cambodia border, can be considered as a public health emergency. Since Thailand has restrictive abortion laws, Cambodian migrant women who have irregular migration status in Thailand experimented with unsafe abortion methods that allowed them to terminate their pregnancies surreptitiously. Unmarried migrant women choose abortion as a preferred birth control method seeking repeat “unsafe” abortions instead of preventing conception. Drawing on the data collected through surveys, in-depth interviews, and document analysis in Chup Commune (pseudonym), Phnom Penh, and Bangkok, the authors describe the public health dimensions of maternal mortality risks faced by unmarried Cambodian migrant women due to various unsafe abortion methods employed as birth control methods.

HIV/STI risk by migrant status among workers in an urban high-end entertainment centre in Eastern China

Large-scale internal migration in China may be an important mechanism for the spread of HIV/sexually transmitted infections (STIs) because of the risk behaviours of migrants. We conducted a self-administered survey among 724 employees of a high-end entertainment centre in Kunshan, Jiangsu Province, China. Using logistic regression, we examined the association of hometown of origin (Kunshan city, elsewhere in Jiangsu Province, or another province in China) and consecutive years living in Kunshan with measures of HIV/STI risk behaviour. We found that increased time living in Kunshan was associated with lower odds of using condoms as contraception [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64-0.95] and consistent condom use with a casual partner (OR = 0.66, 95% CI: 0.47-0.93), after controlling for gender, marital status age and income. The odds of having had an STI were significantly lower for Kunshan natives than those originally from outside provinces (OR = 0.25, 95% CI: 0.07-0.96), but increasing years living in Kunshan was not related to lower risk for an STI. Our findings do not support the hypothesis that migrants living far from home participate in higher risk behaviour than locals. Findings suggest that adaptation to local culture over time may increase HIV/STI risk behaviours, a troublesome finding.