Evolution of HIV Epidemic and Emerging Challenges - China, 1989-2023

Introduction: This study aimed to provide a comprehensive analysis of the human immunodeficiency virus (HIV) epidemiological landscape in China through a historical review and current assessment.

Methods: Data were extracted from China's HIV/AIDS Comprehensive Response Information Management System (CRIMS). Transmission patterns across different phases were visualized using stacked area charts. Geographical correlations between transmission routes were analyzed using scatter plots and Pearson correlation coefficients. The extent and trends of HIV spread among the general population were evaluated using Venn diagrams and Cochran-Armitage tests.

Results: The HIV epidemic in China evolved through four distinct phases: injecting drug user (IDU) dominated (1989-1994), former plasma donor (FPD) outbreak (1995-2005), sexual transmission dominance (2006-2014), and general population spread (2015-present). A strong correlation was observed between provinces reporting high numbers of IDU cases and those with elevated heterosexual transmission (=0.88, <0.001). Between 2015 and 2023, 393,926 cases were identified among the general population through non-marital and non-commercial heterosexual contact (NMNCHC). The proportion of general population cases among heterosexual transmissions increased significantly from 46.2% to 55.7% (=42.7, <0.001).

Conclusion: The significant spread of HIV into the general population necessitates the development of targeted prevention strategies for both high-risk and general populations to address emerging epidemiological challenges.