University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
Department of Sociology, University of California, San Diego, CA, USA.
J Int AIDS Soc. 2018 Jan;21(1). doi: 10.1002/jia2.25039.
Migration of men who have sex with men (MSM) from rural to urban areas is common across low- and middle-income countries and is widely believed to contribute to elevated HIV risk among migrant MSM in urban areas. Little consensus exists on whether their risk is due to their transplantation or their being from resource-constrained rural areas. This study seeks to clarify the relationship between migration and HIV risks by comparing differences in HIV-related risky sexual behaviours and healthcare utilization across competing conceptualizations of migratory statuses.
In July 2016, MSM ≥16 years old currently residing in one of eight urban cities in China were recruited for an online cross-sectional survey, which collected information on socio-demographics, sexual behaviours, HIV care-seeking behaviours, and healthcare utilization. Based on a question about residency status, each participant was classified as an urban local resident, urban transplant, or rural transplant. Multivariable multinomial logistic regression was used to examine the associations between risky behaviours and healthcare utilization among these three groups.
Among 2007 MSM, the proportion of local, urban transplant and rural transplant were 32% (648/2007), 24% (478/2007), and 44% (881/2007), respectively. Compared with urban local resident MSM, urban transplant MSM were more likely to have ever tested for HIV (adjusted odds ratio (aOR) = 1.39, 95% confidence interval (CI): 1.08 to 1.80). Compared with urban transplant MSM, rural transplant MSM were less likely to have utilized any governmental sexual health services in the past three months (aOR = 0.75, 95% CI: 0.60 to 0.93), ever tested for HIV (aOR = 0.77, 95% CI: 0.61 to 0.96), ever initiated antiretroviral therapy (ART) (aOR = 0.16, 95% CI: 0.05 to 0.52), and ever purchased sex (aOR = 0.57, 95% CI: 0.38 to 0.85). No other significant differences were found in sexual behaviours among three groups.
The widely used local/migrant categorization obscures important differences in HIV risk present between urban/rural subgroups among them. Previous studies of HIV risks in Chinese "migrant" may have failed to consider the role of structural factors such as discrimination or barriers to healthcare when interpreting their findings of higher HIV prevalence in this population. Low ART uptake among rural transplant MSM in this study is particularly concerning and underscore the need for HIV-related interventions tailored for this group.
男男性行为者（MSM）从农村向城市地区迁移在中低收入国家很常见，人们普遍认为这导致了城市地区移民 MSM 的 HIV 风险升高。对于他们的风险是由于他们的迁移还是由于他们来自资源匮乏的农村地区，人们并没有达成共识。本研究旨在通过比较不同移民身份概念下与 HIV 相关的危险性行为和医疗保健利用方面的差异，来阐明迁移与 HIV 风险之间的关系。
2016 年 7 月，我们招募了目前居住在中国八个城市之一的年龄在 16 岁及以上的 MSM，进行了一项在线横断面调查，该调查收集了社会人口统计学、性行为、HIV 护理寻求行为和医疗保健利用方面的信息。根据关于居住状况的问题，每个参与者被归类为城市本地居民、城市移民或农村移民。多变量多项逻辑回归用于检验这三组人群中危险行为和医疗保健利用之间的关联。
在 2007 名 MSM 中，本地、城市移民和农村移民的比例分别为 32%（648/2007）、24%（478/2007）和 44%（881/2007）。与城市本地居民 MSM 相比，城市移民 MSM 更有可能接受过 HIV 检测（调整后的优势比[aOR]为 1.39，95%置信区间[CI]：1.08 至 1.80）。与城市移民 MSM 相比，农村移民 MSM 在过去三个月中更不可能利用任何政府性健康服务（aOR 为 0.75，95%CI：0.60 至 0.93）、接受过 HIV 检测（aOR 为 0.77，95%CI：0.61 至 0.96）、接受过抗逆转录病毒治疗（ART）（aOR 为 0.16，95%CI：0.05 至 0.52）或购买过性服务（aOR 为 0.57，95%CI：0.38 至 0.85）。三组人群之间的性行为没有发现其他显著差异。
广泛使用的本地/移民分类掩盖了城市/农村亚组之间存在的 HIV 风险的重要差异。以前对中国“移民”HIV 风险的研究在解释这一人群中 HIV 流行率较高的发现时，可能没有考虑到歧视或医疗保健障碍等结构性因素的作用。本研究中农村移民 MSM 的低 ART 使用率尤其令人担忧，这突显了需要针对这一群体制定 HIV 相关干预措施。
