title: Sexual Mixing in Shanghai: Are Heterosexual Contact Patterns Compatible With an HIV/AIDS Epidemic?
abstract: China's HIV prevalence is low, mainly concentrated among female sex workers (FSWs), their clients, men who have sex with men, and the stable partners of members of these high-risk groups. We evaluate the contribution to the spread of HIV of China's regime of heterosexual relations, of the structure of heterosexual networks, and of the attributes of key population groups with simulations driven by data from a cross-sectional survey of egocentric sexual networks of the general population of Shanghai and from a concurrent respondent-driven sample of FSWs. We find that the heterosexual network generated by our empirically calibrated simulations has low levels of partner change, strong constraints on partner selection by age and education, and a very small connected core, mainly comprising FSWs and their clients and characterized by a fragile transmission structure. This network has a small HIV epidemic potential but is compatible with the transmission of bacterial sexually transmitted infections (STIs), such as syphilis, which are less susceptible to structural breaks in transmission of infection. Our results suggest that policies that force commercial sex underground could have an adverse effect on the spread of HIV and other STIs.
authors.affiliation: Duke Population Research Institute, Sanford School of Public Policy, Department of Sociology and Duke Global Health Institute, Duke University, Box 90312, Durham, NC, 27708, USA, giovanna.merli@duke.edu.
authors.forename: M Giovanna
authors.initials: MG
authors.lastname: Merli
authors.forename: James
authors.initials: J
authors.lastname: Moody
authors.forename: Joshua
authors.initials: J
authors.lastname: Mendelsohn
authors.forename: Robin
authors.initials: R
authors.lastname: Gauthier
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000635:transmission; D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D020010:Heterosexuality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000635:transmission; D055815:Young Adult