Preplanned Studies: Characteristics and Predictors of Interprovincial Migration Following HIV Diagnosis Among Men Who Have Sex with Men — China, 2016–2022

This study reveals significant patterns of post-HIV diagnosis migration among MSM in China, characterized by initial diagnosis in economically developed regions followed by return migration to household registration locations in central and western PLADs for follow-up care. Key factors associated with post-diagnosis migration include age under 50, unmarried status, lower educational attainment, employment as commercial staff or student status, STD history, and diagnosis before 2020.

The findings indicate that approximately 10% of HIV-positive MSM relocated between diagnosis and follow-up, exceeding the migration rate of the general HIV-positive population (7.8%). This elevated mobility among MSM reflects complex intersections of cultural, economic, and health-related factors. Young, single individuals with lower educational attainment and STD history demonstrated higher mobility patterns. These younger, single individuals typically exhibit greater sexual activity, and their engagement in high-risk behaviors during migration may facilitate HIV transmission to the general population, making them crucial targets for intervention strategies. Limited educational attainment often restricts employment opportunities, necessitating increased geographical mobility in search of better prospects. This mobility, combined with potentially limited HIV awareness, increases vulnerability to high-risk sexual behaviors during migration, contributing to HIV transmission patterns (4). Commercial staff, characterized by complex social networks, present particular challenges for AIDS response due to their inherent mobility. Additionally, the marked decrease in migration during 2020–2022 likely reflects the impact of coronavirus disease 2019 (COVID-19) pandemic restrictions, including travel limitations, lockdowns, and economic uncertainty.

Economically developed regions, particularly Guangdong, Beijing, and the Yangtze River Delta (Shanghai-Zhejiang-Jiangsu), attract MSM due to their superior employment opportunities, enhanced anonymity, and greater social acceptance. However, the findings reveal that many MSM subsequently return to their home PLADs, including Anhui, Henan, Sichuan, Hunan, and Hebei, for follow-up care. This pattern aligns with the “coming home” phenomenon described in previous research, which identified proximity to family as the primary motivator for relocation among HIV-infected individuals (5). HIV-positive MSM may face heightened privacy concerns and social stigma in metropolitan areas, making smaller cities or their places of household registration more appealing (6). These familiar environments often provide greater acceptance and understanding (7). This contrasts with findings from the United States, where HIV-positive individuals typically migrate to larger urban centers post-diagnosis, attracted by more favorable healthcare policies, particularly liberal Medicaid coverage (8).

Local insurance policies emerge as crucial determinants of migration patterns. Despite China’s provision of free HIV treatment, non-local MSM encounters significant barriers, including variable testing fees and reduced reimbursement rates, which often compel them to return to their home PLADs. This migration can delay treatment initiation, potentially increasing the risk of drug resistance. Pre-treatment testing fees in major cities vary considerably, ranging from full reimbursement to complete self-payment, imposing substantial economic burdens on migrant patients (9). Furthermore, out-of-province treatment restrictions, including lower reimbursement rates, complex administrative procedures, and extended reimbursement cycles, contribute to patient outflow. It is recommended establishing a streamlined, cross-provincial reimbursement system with a centralized digital platform for efficient claim processing and tracking is recommended. Notably, the findings indicate that a significant proportion of patients-initiated treatment post-migration, increasing their risk of drug resistance. This observation parallels U.S. research showing that 11.3% of HIV-positive individuals discontinued treatment during travel periods (10).

These findings underscore the necessity for targeted services to promote timely treatment among the nearly one-third of migrant MSM who delay treatment initiation. It is recommended that economically developed PLADs consider relaxing household registration requirements, streamlining administrative processes, and reducing policy barriers for non-local residents. Additionally, major cities should enhance transparency in medical insurance policies and ensure timely communication of policy changes to maximize accessibility for non-local patients.

Beyond the major economic centers, PLADs such as Tianjin and Fujian demonstrate notable post-diagnosis out-migration patterns, highlighting the need for comprehensive management protocols for non-local patients. These protocols should encompass strengthened treatment referral mechanisms and enhanced HIV prevention and control measures. The significant inflow to PLADs like Anhui, Henan, and Hunan necessitates effective case management strategies in both origin and destination regions to prevent HIV transmission. To facilitate this, it is recommended that incentive structures be implemented for local governments, such as the allocation of additional funding and resources based on migrant case management metrics. Furthermore, establishing robust partnerships between local health departments, NGOs, and community-based organizations would enable comprehensive care delivery for this mobile population. It is suggested that proactive information-sharing systems and coordinated healthcare provider networks among affected PLADs be implemented to ensure continuity of care and follow-up services. This integrated approach represents an effective long-term strategy for HIV/AIDS management from both public health and individual care perspectives.

This study has several limitations. First, this study only analyzed migration patterns between initial diagnosis and follow-up visits, leaving the precise timing and location of HIV acquisition unknown. Second, detailed data on the time interval between diagnosis and initial follow-up were lacking, highlighting the need for more comprehensive temporal data collection in future research. Despite these limitations, the large sample size and broad geographic coverage of the study provide valuable insights into post-diagnosis migration patterns and significant implications for HIV prevention among mobile HIV-positive MSM populations. Additionally, information on economic status and behavioral characteristics were not examined. Future studies should address these factors to better understand how mobility influences and enhances AIDS response strategies.

The evidence of substantial post-diagnosis migration among HIV-positive MSM in China underscores the critical need for policymakers to address the unique HIV prevention and care requirements of this mobile population. Specifically, tailored behavioral interventions and continuous treatment support must be readily accessible at both origin and destination locations to effectively control HIV transmission and ensure treatment adherence. Implementing comprehensive care strategies throughout the migration process can better protect the health of HIV-positive MSM, reduce transmission rates, and improve treatment outcomes in China.

We would like to express our gratitude to The Public Health Advanced Training Program (PHATP) supported by the Chinese Preventive Medicine Association.