Title : Migration experiences and reported commercial and non-commercial sexual behaviors among newly diagnosed HIV infections in china: A cross-sectional study
Background: Evidence has showed that migration influences human health. China has a high migration rate and a significant number of HIV positive people, but little is known about how these intersect in sexual risk behaviors. Therefore, we aim to explore sexual risk behavior between migrants and non-migrants among newly diagnosed HIV infections, and to assess the changes of sexual risk behaviors with length of stay in the current place of migrants.
Method: A cross-sectional questionnaire survey was conducted among the newly diagnosed HIV people during July, 2018 and December, 2020, who lived in Zhejiang Province. In the study, sexual risk behaviors included unprotected sexual behaviors and having multiple sexual partners (both in commercial sexual behaviors, non-commercial sexual behaviors, heterosexual behaviors and homosexual behaviors). Logistic regression models were employed to explore the influencing factors of sexual risk behaviors, measured by multiple sexual partners and unprotected sexual partners.
Results: In total, 836 newly diagnosed people living with HIV/AIDS were incorporated in the study. The percentages of non-commercial sexual behaviors among migrants were statistically higher than that of non-migrants (39.93%, 218 vs 28.28%, 82) for non-commercial heterosexual temporary sex, 26.56% (145) vs 15.52% (45) for non-commercial heterosexual fixed sex, 1.65% (9) vs 1.38% (4) for non-commercial homosexual behaviors). As for the commercial heterosexual behavior, it was higher among non-migration (51.03%, 148) than that of migrants (39.93%, 218) (P=.002). The percentages of using condom every time during sexual behaviors were higher among migrants than that of non-migrants no matter of commercial sex (10.23%, 18 vs 4.00%, 4) or non-commercial sex (12.40%, 31 vs 5.26%, 4). Among migrants, the probability of sexual risk behaviors increased in the first 3 years (from 27.44%, 45 to 43.40%, 23) and reduced to 28.16% (29) after 9 years for commercial sex. For non-commercial sex, the probability also increased in the first 3 years (from 43.90%, 72 to 63.16%, 48), and then reduced to 44.67% (46) after 9 years. Compared to non-migrants, migrants were statistically associated with multiple sexual partners (P=.006, OR=1.552). However, migrants did not show a significant difference on the unprotected sexual behaviors compared with non-migrants. In addition, migrants aged between 18-45 years and migrated to the current city among 1-3 years tended to have more sexual partners (P<.05).
Conclusion: Newly diagnosed HIV positive people were mobile and engaged in different sexual risk behaviors between migrants and non-migrants. Targeted HIV prevention and sexual health promotion is needed, for example, non-commercial sexual behaviors prevention for migrants, commercial sexual behaviors prevention for non-migrants and healthy sexual education for new arrivals who migrated at the current city for less than 4 years.