Research On HIV Infection,Risk Factors For Transmission,and Survival Status Among Marriage-based Migrant Women In Linyi City

BackgroundThe Acquired Immuno-Deficiency Syndrome(AIDS)has entered a widespread epidemic period in China and it has been gradually spread from high-risk groups to the general population,in which the floating population has functioned as a bridge.Marriage-based migrant women is a special group of floating population.In 2003,it was firstly found in Shandong Province that Marriage-based migrant women were the key population of HIV infection,and the definition of the population and related survey were carried out.After that,several other provinces and cities have conducted similar researches.The result indicated that the HIV infection rate of marriage-based migrant women was higher than the national general population and resulted in the transmission of HIV between spouses and mother-to-fetus transmission in the family.Linyi is the most infected city in Shandong province.Since 2004,Linyi City has carried out investigation and routine surveillance among marriage-based migrant women.The newly discovered HIV-infected people have been timely interviewed through epidemiological and followed up.In order to further understand the survival status and the flow of marriage-based migrant women,a survey on HIV infection was conducted among the group in Linyi city.Based on the data of special investigation,routine surveillance,epidemiological investigation,follow-up and current situation of marriage-based migrant women in Linyi City,this study systematically analyzed the epidemiological characteristics of AIDS among marriage-based migrant women,the secondary transmission of HIV in family and its influencing factors,the migration situation,the causes and the survival status of migrant women,etc,thus to provide scientific basis for prevention and control of AIDS.ObjectiveBy analyzing the epidemic characteristics of AIDS among marriage-based migrant women,the secondary transmission in the family and the risk factors,by describing migration track and its influencing factors among marriage-based migrant women and by understanding the survival status of the group and their families living in Linyi,so as to establish and improve the AIDS prevention and control system for this population.MethodsA retrospective cohort study was conducted.The cohort was built based on the baseline data of HIV infection among marriage-based migrant women in Linyi City and then collected the data of routine surveillance,epidemiological investigation and follow-up.The survival status and the migration of marriage-based migrant women infected with HIV and their spouses were investigated simultaneously.Results1.By May 31,2018,258 cases of HIV/AIDS patients were investigated among 16 605 marriage-based migrant women.The HIV infection rate was 1.55%and significantly different by years and counties(P<0.05).The cases were detected mainly from 2004 to 2010.They were mainly farners,ethnic minorities,from Yunnan Province and Myanmar,young adults,heterosexual transmission and mainly detected through the special investigation of marriage-based migrant women.A total of 73 spouses were infected and the transmission rate of HIV between husband and wife was 30.67%.Binomial logistic analysis showed that "years of unprotected sexual life","whether they had heard of AIDS before",and "the frequency of sexual life before one spouse being confirmed HIV positive" were the influencing factors of HIV transmission between husband and wife(P<0.05);Cox regression model indicated that the low condom use rate in the sexual life of couples in single-positive families increased the risk of HIV infection(P<0.05).The mother-to-child transmission rate of HIV was 20.00%(21/105).The probability of mother-to-child transmission could be reduced by taking three measures:cesarean section,artificial feeding and drug blockade(P<0.05).2.There was 54.90%of the marriage-based migrant women flowing into Linyi because of "poverty of their origin and pursuit for better economic conditions",39.82%were sold/abducted to Linyi,70.22%of the spouses married marriage-based migrant women because of "family poverty and unable to marry the local woman"reasons.60.08%of the HIV-infected marriage-based migrant women had already flowed out of Linyi.Cox regression analysis showed that the disease status,inflow route and spouse HIV infection status were the main influencing factors for flowing out among the marriage-based migrant women(P<0.05).Among the causes of outflow of HIV-infected marriage-based migrant women,63.87%were abandoned sent away or separated after HIV infection and 16.77%disliked the life in Linyi.92.94%of the marriage-based migrant women returned to their native place,and 9.03%of them were currently being followed up by local medical and health institutions.3.Among the marriage-based migrant women who did not flow out of Linyi,50.49%had died,mainly from AIDS-related diseases.Cox regression analysis showed that the non-recipients of antiviral therapy and baseline CD4+T lymphocyte count ≤200/μ1 increased the risk of death among HIV-infected marriage-based migrant women(P<0.05).At present,there were 51 HIV-infected marriage-based migrant women in Linyi city being followed up and managed,88.24%of them have adapted to the local life,believed that Linyi was better than their hometown and had no intention of returning to their native place;66.67%were supported by their families,kept in touch with each other and had returned to visit their relatives;there were 76.47%participants getting the understanding,help and care from their spouses.Children were the main driving force in their lives.78.43%of the HIV-infected marriage-based migrant women had accepted the fact that they were infected with HIV,but 11.76%(6/51)of them still hadn’t;In the past month,82.35%of them had anxiety worry and uneasiness with varying level,all of them had been troubled by illness,physical discomfort,pain or fear of illness.The spouse’ s acceptance of HIV infection,good relationship and satisfaction with living with marriage-based migrant women were the main factors to maintain living together.54.90%of husbands stated that the main reason for living with marriage-based migrant women was inseparable feelings.85.39%of the marriage-based migrant women,their spouse’s family income were at the low level of the village.4.The HIV-infected marriage-based migrant women and their families were mainly faced with three problems:health,economy and children.Health problems mainly included unhealthy body,side effects of medication,drug resistance,opportunistic infections,psychological pressure and less social support.The poor family’ s economic conditions of marriage-based migrant women mainly because of physical unhealthy,ageing and no skills,thus led to the feeling of inability to educate and cultivate their children,and the sense of guilt for children would increase the pressure and anxiety of parents.Conclusions1.The HIV infection rate of marriage-based migrant women is high,which has a great impact on the AIDS epidemic in Linyi City,resulting in an increase in the number of AIDS epidemics in Linyi City and causing a large number of secondary transmission cases.In unknown circumstances,the transmission rate of HIV between husband and wife is higher.There is still a phenomenon of spouse infected with HIV in single-positive families.Many couples cannot achieve 100%condom use.Most marriage-based migrant women did not accept the whole blocking measures from mother to child when delivery.2.The marriage-based migrant women mainly migrate for the purpose of improving living conditions,or are lured by criminals to other places.Adult males in some rural areas of Linyi City are unable to marry locally because of poor economic conditions,and marry marriage-based migrant women for the purpose of sex and patriarchal succession.The "push-pull" two forces form a joint effort to promote the flow of marriage-based migrant women.3.More than half of the HIV-infected marriage-based migrant women have flowed out of Linyi,the main factors affecting the outflow of them are the way to marry into Linyi and the HIV test results of their spouses;The main outflow route is that being abandoned by their spouses and their families after being confirmed HIV-positive;The whereabouts are mostly unknown and less of them return to their original places,the possibility of settling into a family in other places cannot be ruled out.4.Among the HIV-infected marriage-based migrant women who stay in Linyi,most of them keep a good relationship with their spouses,can get spouse’s attention,adapt to local life and have more support from their origin family.The marriage-based migrant women are facing three major problems regarding health,economy and children.Most of them live in poverty and have a poor quality of life.The annual income of them is at a low level compared with others in the same village.