Human immunodeficiency virus (HIV) remains a major epidemic in China. GlobalData’s epidemiology report on HIV showed a steady increase in the number of people living with HIV in China, from around 651,000 in 2005 to 850,000 in 2015. In addition, the report analysis showed men are disproportionally affected by HIV versus women in China, where the prevalence in men is four times as high as in women. A recent study by Gao and colleagues published in July 2019 in the PLOS One journal reported that HIV/AIDS mortality trends mirror the trend in prevalence, showing an increase over time and a gender gap skewed towards men.

Figure 1 presents the total prevalence compared with mortality of HIV/AIDS from 2005–2015. It’s clear that both prevalence and mortality are higher in men than women, and also increase faster in men than women. The gender gap in HIV epidemiology is also large for mortality, where HIV/AIDS mortality is three times as high in men as in women. The data also suggest that the gender gap is widening.

The skew in men in China is consistent with other populations such as South Africa and Malawi, but HIV epidemiology in China has a unique history and profile. The question now becomes, what is driving the widening gap in China? China has a population of HIV cases as a result of contaminated blood transfusions. In addition, due to the severe stigma associated with being homosexual men and strong cultural norms, most men who have sex with men (MSM) often end up married to women. Considering these circumstances, women are more at risk of HIV than in some populations. However, several factors favour women over men in both disease transmission and survival. Gao and colleagues suggest that the widening gap in prevalence is due to an increase in MSM from 1.5% in 2006 to 23.4% in 2018, and increase in risky behaviours. Second, the average life expectancy of women in China is better than men. Third, the lower mortality in HIV-positive women specifically may also be attributed to better disease prognosis and treatment outcome in women than men. While mortality globally for HIV/AIDS is decreasing, the increasing trend in China is concerning and deserves immediate action.