Expansion of HIV/AIDS in China: lessons from Yunnan Province

Abstract

In this article we systematically and critically review the Chinese and English language literature on human immunodeficiency virus (HIV)-related studies in Yunnan Province, Southwestern China. Yunnan Province had the first Chinese HIV outbreak and is still the worst affected area in the nation. Since 1989, HIV infection has extended from injecting drug users into the general population through sexual transmission. Since the economic reform of the 1980s, changed social norms and increased migration have spawned increases in HIV-related risk behaviors such as drug use and commercial sex work. A smaller size of "bridge" populations and lower sexual contact rates between persons in "bridge" and general populations may explain the slower expansion of the HIV epidemic in Yunnan compared to nearby Southeast Asian nations. In 2004, women in antenatal care had a 0.38% HIV prevalence province wide, although >1% infection rates are seen in those counties with high injection drug rates. Patterns of drug trafficking have spread the unusual recombinant HIV subtypes first seen in Yunnan to far-flung regions of China. Increased efforts of Yunnan's HIV control program are correlated with an improved general HIV awareness, but risk behaviors continue at worrisome rates. Future efforts should focus on changing risk behaviors, including harm reduction and condom promotion, especially among the "bridge" groups. The resurgence of commercial sex work in Yunnan, and the high frequency of workers migrating into provinces far from home and family are all sociocultural factors of considerable importance for future HIV and sexually transmitted disease control in China.

Fig. 1

Map of Yunnan Province.

Fig. 2

HIV prevalence among IDUs in Yunnan Province, 1992–2004.

Figure 3

HIV prevalence among high-risk populations in Yunnan Province (Note: HIV prevalence among IDUs on the left axis, HIV prevalence among other populations on the right axis).

Fig. 4

Annual reported HIV cases in Yunnan Province and China and the percentage of Yunnan HIV cases among China#x02019;s cases (Note: 1. the arrows indicate the years that other high HIV prevalent provinces/regions found their first HIV infections; 2. the increase of HIV cases in 2004 is due to the large-scale HIV testing program in Yunnan Province).

Figure 5

Annual reported STI cases in Yunnan Province and China (Note: number of national STI cases on the left axis, number of Yunnan STI cases on the right axis. Although the first STI found in Yunnan Province was in 1984, the available Yunnan STI data is from 1989 to 2001).