Prevention of Heterosexual Transmission of HIV

Heterosexual transmission now accounts for over two-thirds of all newly diagnosed HIV cases in China, making it the dominant transmission route. The significant societal changes, brought about by the opening of China’s boarders and the dramatic economic reform in the late 1970s and early 1980s, have increased personal wealth disparities, created large-scale internal labor migrations, and liberalized sexual norms, all of which have facilitated the rapid growth in heterosexual transmission of HIV. Currently, prevalence in the general population remains low. Therefore, prevention and response efforts for the heterosexual epidemic have concentrated on key populations, including female sex workers, migrants, attendees of sexually transmitted infection clinics, and serodiscordant couples. While interventions such as condom promotion, testing, and health education have been successfully implemented for these long-recognized key populations, the rapid growth of HIV cases in populations such as older adults indicates that there is a need for new approaches to HIV prevention in an evolving epidemic. Additional research is needed to understand transmission dynamics and sexual networks and implementation of effective interventions. Finally, difficult questions that have arisen following opening up and reform, such as economic inequality, the criminalization of sex work, and internal migration, must be addressed to further facilitate HIV prevention efforts.