Academic journal article Demographic Research

Masculine Sex Ratios, Population Age Structure and the Potential Spread of HIV in China

Academic journal article Demographic Research

Masculine Sex Ratios, Population Age Structure and the Potential Spread of HIV in China

Article excerpt


There is much speculation regarding the contribution of China's changing demography to the spread of HIV/AIDS. We employ a bio-behavioral macrosimulation model of the heterosexual spread of HIV/AIDS to evaluate the roles that China's unique demographic conditions - (1) masculine sex ratios at birth and (2) a population age structure that reflects rapid fertility decline since the 1970's - play in altering the market for sexual partners, thereby potentially fueling an increase in behaviors associated with greater risk of HIV infection. We first simulate the relative contributions of the sex ratio at birth and the population age structure to the oversupply of males in the market for sexual partners and show that the sex ratio at birth only aggravates the severe oversupply of males which is primarily a consequence of the population age structure. We then examine the potential consequences of this demographic distortion for the spread of HIV infection and show that, to the extent that males adapt to the dearth of suitable female partners by seeking unprotected sexual contacts with female sex workers, the impact of the oversupply of males in the sexual partnership market on the spread of HIV will be severe.

1. Introduction

At the end of 2007, China's HIV/AIDS epidemic was classified as "low level", with an estimated 700,000 people living with HIV, corresponding to 0.05 percent of the adult population (UNAIDS 2008). While until now HIV in China has been concentrated among relatively well-defined population subgroups, such as users of injected drugs, former plasma and blood donors and female sex workers and their clients (State Council AIDS Working Committee Office 2007; Wu, Rou, and Cui 2004), new evidence suggests that HIV is spreading from these traditional high-risk groups to the general population through heterosexual contact. The proportion of HIV infections resulting from heterosexual transmission is growing, such that these accounted for half of all new cases in 2005 (MOH, UNAIDS and WHO 2006, Kerr 2005). Heterosexual transmission between high-risk groups and the general population is especially evident in the southern regions of the country, where China's HIV epidemic first took root (Gill, Huang, and Lu 2007; MOH, UNAIDS and WHO 2006; Lin et al. 2008).

The extent to which HIV will continue to spread to the general population in China depends largely on the levels and distribution of sexual activity. Results of an empirically grounded compartmental model suggested that in China, overall levels of sexual activity (identified by the rate of partner change) and the fraction of the population with multiple partners would have to be significantly higher than those currently observed in order for HIV prevalence to exceed one percent at any time during a 50-year simulation cycle (Merli et al. 2006). These results, however, do not imply that concerns about continued spread of HIV in China's general population are unwarranted. On the contrary, there are good reasons to suspect that sexual activity in China could contribute to a larger, more widespread HIV epidemic in the future. For example, China's increasingly liberal social and economic environment includes increasing prevalence of higher-risk sexual behaviors, such as casual or concurrent partnerships and commercial sexual activity (Farrer 2002; Sigley and Jeffreys 1999, Parish, Mojola, and Laumann 2007). In addition, as will be explored in this paper, it has been suggested that China's unique demographic conditions have the potential to further influence the sexual landscape in such a way as to place an increasing proportion of the population at risk for HIV infection.

Two features of China's demographic profile are hypothesized to potentially shift the distribution of the sexually active population towards higher rates of partner change and more widespread adoption of risky behaviors in the future: (1) highly masculine sex ratios at birth; and (2) the population age structure that reflects the rapid, widespread fertility decline which began in the early 1970's. …

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