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Migration is a major risk factor for the spread of human immunodeficiency virus (HIV) (1). In China, 7.8% of HIV-positive individuals moved inter-provincially after their first follow-up (2). Men who have sex with men (MSM) play a bridging role in HIV transmission, with an average prevalence of HIV among MSM in China of 5.7% [95% confidence interval (CI): 5.4%–6.1%] between 2001 and 2018 (3). Guangxi Zhuang Autonomous Region is one of the provincial-level administrative divisions (PLADs) with the largest number of HIV-positive individuals in China, and the proportion of MSM in newly confirmed HIV individuals increased from 0.93% to 6.53% between 2010 and 2017 (4). The migration network among HIV-positive MSM has facilitated HIV transmission in Guangxi (5). However, the current migration status of HIV-positive MSM in Guangxi is unknown. In this study, HIV-positive MSM aged 18 years or older and diagnosed between 2005 and 2021 were extracted from the National Integrated HIV/AIDS Control and Prevention Data System.
Participants with follow-up addresses that differed from their baseline addresses were classified as prefecture-level migrants, while those with the same addresses were classified as non-migrants. The prefectures in the Guangxi Zhuang Autonomous Region included Nanning, Liuzhou, Guilin, Wuzhou, Beihai, Fangchenggang, Qinzhou, Guigang, Yulin, Baise, Hezhou, Hechi, Laibin, and Chongzuo. The temporal trend of the proportion was assessed using a simple linear regression model, and risk factors were analyzed using a multivariable logistic regression model. This study was approved by the Ethics Review Board of Guangxi Center for Disease Control and Prevention (Certificate No.: GXIRB2016-0047-1).
Among 5,621 HIV-positive MSM, 1,733 (30.8%) were migrants. Compared with non-migrant MSM, migrant MSM had distinct characteristics: 18–24 years of age (44.8% vs. 28.8%), unmarried status (86.4% vs. 72.2%), belonging to the Han ethnic group (69.3% vs. 62.6%), education level of college and above (63.9% vs. 39.6%), and being a student (25.8% vs. 9.8%) (Table 1).
Characteristic Non-migrant MSM
N (%) (n=3,888)Migrant
N (%) (n=1,733)χ2 P Age (years) 195.543 <0.001 18–24 1,120 (28.8) 776 (44.8) 25–49 2,377 (61.1) 915 (52.8) ≥50 391 (10.1) 42 (2.4) Marital status 138.163 <0.001 Unmarried 2,807 (72.2) 1,496 (86.4) Married 799 (20.5) 155 (8.9) Divorced 282 (7.3) 82 (4.7) Ethnic group 38.130 <0.001 Han 2,435 (62.6) 1,200 (69.3) Zhuang 1,285 (33.1) 434 (25.0) Other 168 (4.3) 99 (5.7) Education background 327.517 <0.001 College and above 1,539 (39.6) 1,107 (63.9) Senior high school 1,028 (26.4) 376 (21.7) Junior middle school 1,042 (26.8) 211 (12.2) Primary school and below 279 (7.2) 39 (2.2) Occupation 418.293 <0.001 Student 381 (9.8) 447 (25.8) Domestic service and unemployed 996 (25.6) 413 (23.8) Private company employee 536 (13.8) 295 (17.0) Farming or factory worker 1,146 (29.5) 174 (10.0) Government employee 361 (9.3) 149 (8.6) Other 468 (12.0) 255 (14.8) Abbreviation: HIV=human immunodeficiency virus; MSM=men who have sex with men. Table 1. Demographic characteristics of HIV-positive MSM categorized by prefecture-level migration status in Guangxi, China, 2005–2021.
The proportion of migrant HIV-positive MSM increased from 0% in 2005 to 33.3% in 2006 and 35.1% in 2021, with an average proportion of 27.2% (Figure 1). This showed an upward trend of the proportion of migrant HIV-positive MSM from 2009 to 2021 (R2=0.608, P=0.002).
Figure 1.Temporal trend of the number of newly reported HIV-positive MSM and the proportion of migration in Guangxi from 2005 to 2021.
Abbreviation: HIV=human immunodeficiency virus; MSM=men who have sex with men.There was a complex network of migration among HIV-positive MSM in Guangxi. The prefectures with the highest number of out-migrant MSM in Guangxi were Yulin (219, 12.6%), followed by Baise (123, 7.1%), Guilin (116, 6.7%), Hechi (107, 6.2%), and Guigang (105, 6.1%). The total number of out-migrants from Guangxi to other regions of China was 468, accounting for 27%. The top five prefectures with the highest number of in-migrant MSM populations in Guangxi were Nanning (968, 55.9%), followed by Liuzhou (138, 8%), Guilin (125, 7.2%), Beihai (68, 3.9%), and Baise (26, 1.5%). The total number of in-migrants from other regions of China to Guangxi was 288, accounting for 16.6%. The risk factors of prefecture-level migration included those aged 18–24 years [compared with those aged ≥50 years, adjusted odds ratio (aOR)
=2.718, 95% confidence interval (CI): 1.851–3.991], those aged 25–49 years (compared with those aged ≥50 years, aOR=2.292, 95% CI: 1.605–3.273), having college education level and above (compared with primary school education level and below, aOR=2.176, 95% CI: 1.499–3.159), and being a student (compared with other occupations, aOR=1.545, 95% CI: 1.231–1.939) (Table 2). Characteristic OR (95% CI) P aOR (95% CI) P Age (years) 18–24 6.444 (4.628–8.974) <0.001 2.718 (1.851–3.991) <0.001 25–49 3.581 (2.581–4.967) <0.001 2.292 (1.605–3.273) <0.001 ≥50 1 1 Marital status Unmarried 2.744 (2.285–3.296) <0.001 1.187 (0.959–1.469) 0.115 Divorced 1.499 (1.110–2.024) 0.008 1.299 (0.949–1.778) 0.103 Married 1 1 Ethnic group Han 0.836 (0.646–1.082) 0.174 0.887 (0.675–1.166) 0.391 Zhuang 0.572 (0.436–0.750) <0.001 0.626 (0.469–0.834) 0.001 Other 1 1 Education background College and above 5.161 (3.659–7.278) <0.001 2.176 (1.499–3.159) <0.01 Senior high school 2.626 (1.841–3.746) <0.001 1.346 (0.923–1.963) 0.123 Junior middle school 1.452 (1.007–2.095) 0.046 1.028 (0.704–1.502) 0.885 Primary school and below 1 1 Occupation Student 2.132 (1.750–2.596) <0.001 1.545 (1.231–1.939) <0.001 Farming or factory worker 0.276 (0.223–0.342) <0.001 0.419 (0.333–0.525) <0.001 Government employee 0.750 (0.591–0.951) 0.018 0.699 (0.546–0.895) 0.004 Domestic service and unemployed 0.752 (0.626–0.903) 0.002 0.775 (0.643–0.935) 0.008 Other 0.988 (0.802–1.217) 0.909 1.033 (0.835–1.278) 0.765 Private company employee 1 1 Abbreviation: MSM=men who have sex with men; OR=odd ratio; aOR=adjusted odds ratio; CI=confidence interval. Table 2. Logistic regression analysis of associated factors influencing prefecture-level migration among HIV-positive MSM in Guangxi, China, 2005–2021.
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