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Demography
Published in: Demography 3/2015

01-06-2015

Sexual Mixing in Shanghai: Are Heterosexual Contact Patterns Compatible With an HIV/AIDS Epidemic?

Published in: Demography | Issue 3/2015

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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.
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Appendix
Available only for authorised users
Footnotes
1
Nonmarital partners could include previous marital partners of currently remarried respondents or of divorced but currently unmarried respondents.
 
2
The rationale for limiting the analyses to first marriages is because in cross-sectional data on prevailing marriages gathered from multiple birth cohorts, first marriages can lessen biases due to variation in marriage timing and divorce rates, which may affect the degree of resemblance between spouses in a cohort (Kalmijn 1991; 1998; Mare 1991; Qian 1998; Qian and Preston 1993; Raymo and Xie 2000). We do not expect this exclusion to be problematic for our analyses. Because remarriage and divorce are rare in this setting, there is no current evidence of differential risk for STI exposure by marital status. Inclusion of this additional stratifying feature in our models and measures would have created estimation issues as the cell sizes are too small to provide stable mixing estimates. However, because divorce and remarriage are likely to become increasingly prevalent in China, this is an area deserving attention in future work.
 
3
The advantages of this randomized draw procedure over other graph simulation approaches—particularly exponential random graph models (ERGM) (e.g., Goodreau et al. 2009)—is mainly computational efficiency. We can generate large networks consistent with our population in mere seconds, which we can then evaluate for connectivity features. Because the information we have is purely at the node and dyad level—including no other edge-dependent features—the resulting models are effectively identical to a dyad-independent ERGM similarly based on node mixing and degree. The addition of the assortativity features creates some level of dependence, but in practice, these are largely determined by birth cohort/education differences in degree.
 
4
We assessed the extent to which variation in the setting of FSW degree affected the sizes of the maximum component and the bicomponent, but their distributions did not vary significantly. The mean of the maximum component varied from 15.7 % to 16.7 % of all nodes with each of the three settings of FSW degree, while the mean of the bicomponent varied from 10.7 % to 9.8 % of the largest component; this suggests that a key feature of these simulated networks is the base frequency distribution of the degree of vertices, not variation in the FSW degree settings. To push this assumption of the model, we ran additional simulations allowing the tail of the FSW degree distribution to reach as high as 250; we found no difference in the epidemic potential measures.
 
5
This image is generated by a single run with values chosen to represent the middle of the value ranges used in the complete simulation experiment. We choose a maximum FSW degree of 60 with M = 27,500 edges.
 
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Metadata
Title
Sexual Mixing in Shanghai: Are Heterosexual Contact Patterns Compatible With an HIV/AIDS Epidemic?
Publication date
01-06-2015
Published in
Demography / Issue 3/2015
Print ISSN: 0070-3370
Electronic ISSN: 1533-7790
DOI
https://doi.org/10.1007/s13524-015-0383-4

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