Reward And Risk: Migration And The Spread Of AIDS In China

By Xiushi Yang

It is a disease whose origins are still debated. Its impact is not: even with advanced medical treatment, a large majority succumb. What is clear is that contemporary technology — more specifically, jet travel and the widespread multinational, multicultural practice of routine movement between continents — has enabled the human immunodeficiency virus, or HIV, to spread easily throughout the world.

HIV’s deadly result — acquired immune deficiency syndrome (AIDS) — has devastated populations in certain of the world’s regions. In Africa, for example, AIDS has exacted a terrible toll, as whole villages in some areas have fallen victim, leaving a generation of children parentless.

Only a decade ago, Asia seemed to be immune to AIDS. No longer. More new HIV/AIDS cases are now being reported from Asia than from any other world region. Asia trails only Africa in terms of the total number of those infected with HIV/AIDS. In southeast Asia in particular, the annual increase in the number of cumulative HIV infections now greatly exceeds those recorded in Africa.

China has only relatively recently joined the list of Asian nations with reported AIDS cases. Since 1990, when the first cases of AIDS among Chinese nationals were reported, the epidemic has accelerated. By 1998, researchers confirmed HIV infections in 12,600 individuals, with the actual number estimated to be many times higher, on the order of 400,000.

No geographic area or population group has been immune to the spread of the disease. The potential for a widespread eruption of AIDS in China is further heightened by a general lack of AIDS awareness and a rapid increase in reported sexually transmitted diseases (STDs), with 460,000 new cases reported nationwide in 1997 alone.

What are the root causes of the arrival and quick spread of HIV in China? To what extent is the spread of HIV in China related to the ongoing process of economic liberalization and the resultant and ever-growing transient population? Who are most susceptible to HIV infection and what are the social, economic and behavioral correlates?

Providing answers to these interrelated questions is the primary purpose of an upcoming project that will study empiricallythe link between temporary migration, risky behavior and HIV infection in southwestern China. The investigation will involve researchers from Old Dominion University, Johns Hopkins University, the Chinese Foundation for the Prevention of STDs and AIDS, and the Chinese Academy of Preventive Medicine. To underwrite the study, the National Institutes of Health and the National Institute on Drug Abuse are providing a $1 million-plus grant over five years.

A Disease In Context

While the immediate cause of AIDS is the virus called HIV, social, cultural and contextual factors determine the behavior that is at the core of HIV transmissions. These factors explain why there are significant differences among different population groups in the level of HIV prevalence and the rate of its transmission. We believe that the arrival and quick spread of HIV in China can be best understood in the context of the profound social, economic and behavioral changes the country has been experiencing, which have facilitated the diffusion of behaviors such as the use of injectable drugs and prostitution. In particular, our thesis is that a growing transient population is a key contributing factor in the increase and diffusion of socially deviant and epidemiologically high-risk behavior in China.

The link between population mobility and the spread of HIV/AIDS has been well established. From the epidemiological point of view, the spread of infectious diseases such as HIV has always been associated with the movement of people. Migration brings more people into close contact and creates a greater mixing of people at places of destination, which provides a ready environment for viral transmissions. Through the movement of infected persons, migration can in turn also offer a convenient vehicle to transport diseases to places where they are previously unknown. We argue that population mobility is more than a transporter of HIV; it breeds broader social and behavioral changes that make temporary migrants particularly susceptible to HIV infections. Population mobility needs to be studied in its own right as one of the root causes of HIV’s spread.

Isolation, Frustration And Behavior

Economically, temporary migrants have historically worked at jobs that are dirty, dangerous and dead end, with the least social prestige. For most temporary migrants in China, the lack of official residence registration in a city represents a formidable barrier in the urban job market, where most decent jobs often require such registration. This structural barrier, combined with migrants’ lack of education, occupational skills or personal or social connections, makes it very difficult to compete with urban natives for mainstream jobs. Temporary migrants therefore perform labor avoided or shunned by urban natives, who would rather be unemployed than accept jobs seen as less than honorable.

Socially and culturally, most temporary migrants are isolated from traditional society in the urban area in which they live. Although they benefit from the existence of an informal village-based network that helps them find jobs in the city, migrants are also insulated from the mainstream. Most temporary workers from the same village live together in rented apartments or at their place of work, such as construction sites, restaurants and living quarters provided on-site by factories. Few temporary migrants have neighbors, friends or co-workers who are local urban residents; their social interaction in the city does not go beyond that with their fellow villagers. Therefore, despite limited economic success relative to what was possible at home in the countryside, migrants experience little social or cultural assimilation and thus feel helpless, insecure, discontented and resentful.

Moreover, the separation of temporary migrants from their families and the transient nature of their employment and residence cut temporary migrants loose from both normative and formal social control mechanisms. Without families, and finding themselves in the more anonymous urban environment, migrants feel less constrained by social norms. Lack of residence registration and permanent-residence status further erodes normative control because of the absence of hometown grassroots organizations, such as neighborhood committees and working units, that otherwise establish societal expectations and exercise behavior constraints.

City governments have trouble controlling temporary migrants because the workers have no permanent jobs or fixed address. Furthermore, governments in the village of origin cannot possibly track or hold accountable the behavior of distant workers.
While not all temporary workers fall into the categories described above, the majority in contemporary urban China are economically marginalized and socially isolated, greatly limiting opportunities for stable employment and upward social mobility. Largely free of social as well as normative controls, and consequently prone to deviant behaviors, some have turned to prostitution and drugs — the main channels of HIV transmissions — as a way to escape their loneliness, frustration and social isolation.

To determine the accuracy of our thesis, we will interview face-to-face a random sample of about 8,000 individuals between 18 and 55 years of age to collect detailed individual, household and community background information. This rich quantitative information will be further augmented with qualitative information from focus-group discussions among 150 individuals randomly selected from the 8,000 interviewees. The data collected will be the first of its kind, allowing us to systematically examine the social, economic and behavioral determinants of risky behavior and HIV infection, with a particular focus on the role of temporary migration.

The findings should prove of great value not only for understanding the underlying dynamics characterizing population mobility, risky behavior and STD/HIV infections, but also in designing effective prevention programs directed at the root cause of the spread of STDs and HIV in China. We believe the socioeconomic processes experienced by temporary migrants in China, which lead to STD and HIV infection and transmission, also characterize to a great extent the experience of labor migrants and illegal international migrants elsewhere. If so, our findings will have theoretical and practical relevance throughout the world.

Xiushi Yang is an associate professor in Old Dominion’s Department of Sociology and Criminal Justice and teaches graduate courses in international studies