社会人口转型下艾滋病性传播风险的多级放大与治理研究

In China, Human Immunodeficiency Virus (HIV) spreading rapidly has lead to serious public health problems, and sexual contact has been the primary mode of HIV transmission patterns. The large migrants from rural to urban areas were supposed to be the bridge for HIV transmission. Additionally, China has experienced a continual increase in the sex ratio at birth since the 1980s, which has led to a serious gender imbalance. With the massive migration, most of the surplus men will migrate to urban areas for work and marriage opportunities, where the more open cultural environment and convenient service increase the probability of engaging in commercial sex. The surplus men who was supposed to be the most-at-risk group will further accelerate the spread of HIV/AIDS transmission along with increased migration. It is the key to identify the epidemic pattern, mechanism and effect of HIV over-regional diffusion along with migration for HIV prevention and intervention in gender imbalance society..To explore the methanism and effect of how HIV is spreading rapidly through sexual contact under the context of serious gender imbalance and a great amount of farmers migrating from rural area to urban area in China,this study will construct a theoretical framework of how gender imbalance and migration may amplify the risk of HIV transmission and propose related research hypothesis,based on theory and case study.The Theory of Risk Social Amplification is provided by Kaserso (1988) as basic framework, and integrated other theories. A set of corresponding models will be developed in this progress. Analyses at micro and macro level will be conducted to explore the mechanism of how HIV sexually transmissive risk is amplified from individual risk to community risk and from community risk to society risk: (1) how gender imbalance and migration increase individual sexual risk at micro level;(2)whether distribution of gender imbalance and floating population correlate to the regional distribution of HIV infection at macro level.Based on the above research findings, a set of strategies and tools of prevention and intervention will be designed to deal with such risk amplification. This project might expand the theoretical views of HIV infection and spread by explaning why HIV sexual epidemic risk is increasing rapidly in the view of gender imbalance and migration, contribute to the analysing techniques of HIV sexual transmission, and provide effective governing ideas under the context of migration and gender imbalance in China.

本项目系统地研究中国社会在“严重性别失衡”与“人口流动普遍化”双重背景下艾滋病性传播比重上升的机理、效应与对策。首先在理论研究和案例分析的基础上，以风险的社会放大理论为依据，融合其他理论，建构性别失衡与人口流动放大艾滋病性传播风险的理论分析框架和具体分析模型，并形成研究假设。然后采取实证研究方法，从微观和宏观层次，分析性别失衡与人口流动因素对艾滋病性传播风险跨区域扩散的影响，揭示艾滋病经性途径传播的风险由个体层次到社区层次再到社会层次的三级放大机制，并采用仿真的方法模拟性别失衡与人口流动的放大效应。最后，从根源性治理和放大途径阻断两方面，研究应对艾滋病性传播的根本途径、关键环节和操作要点。本研究解释了一直以来中国艾滋病性传播比重持续上升的机理，从性别失衡与人口流动视角，丰富和完善了艾滋病扩散理论，改进了艾滋病性传播风险分析技术，为转型期中国政府的艾滋病防治提供有效对策。

艾滋病经性途径传播的防控问题，是当前中国艾滋病治理与防控的主要矛盾。中国正处于社会人口转型阶段，以性别结构失衡和人口流动为主导的各类因素，调整和改变了艾滋病传播经性途径的感染扩散机制，影响着艾滋病性传播风险。因而，有必要深入探讨社会变迁影响艾滋病性传播的复杂机理与对策。.本项目综合利用包括中国疾控中心及公共卫生数据平台的艾滋病数据库、中国统计年鉴、历次人口普查、青年学生艾滋病感染案例在内的公开数据资料，及针对女性性工作者、农村大龄未婚男性、男性流动人口的质性访谈资料和专项问卷调查数据，分析和归纳了中国人口的性别结构、空间迁移，以及艾滋病传播的规模变化与空间分布态势，系统地研究了人口流动和性别失衡因素对我国艾滋病性传播风险的增幅作用、放大机制与治理对策。研究不仅揭示出来自个体、家庭或社会的脆弱性特征影响着性风险行为选择，是艾滋病性传播风险的根源；而婚姻状态、流动经历、社会关系网络和性关系网络结构特征，也是艾滋病性传播风险放大的重要驱动因素。研究也呈现出了HIV/AIDS性传播风险跨人群、跨空间扩散的影响因素、扩散途径及整体效应。据此，提出从微观层面应对个体脆弱性特征、中观层面阻断性关系网络传播、宏观层面治理跨区域人口迁移扩散影响，对艾滋病性传播风险进行系统干预、分级治理的思路。.研究以风险的社会放大理论为基础融合不同艾滋病传播理论，从性关系网络扩张的视野，初次揭示了在性别失衡和人口流动下性活跃群体的艾滋病性传播风险如何由个体脆弱性特征发端，通过社区影响网络、群间性关系网络，以及跨区域人口迁移网络三级放大的特征、机理及对策。相关研究成果对艾滋病防控的研究和实践有重要参考价值。