The Chinese population is believed to be in the early stages of an HIV/AIDS epidemic,
and concerns are great that the epidemic may soon spread to the general population via
heterosexual transmission. Using a bio-behavioral macrosimulation model driven by
realistic input parameters from the Chinese Health and Family Life Survey (CHFLS), we
evaluate the implications of China’s regime of sexual relations for the future course of
HIV/AIDS in the world’s largest population. Our results illustrate the importance of
accounting for prevailing patterns of sexual behavior in the Chinese population. They
show that, under the prevailing regime of sexual relations, as measured by the CHFLS,
the simulated adult HIV prevalence rate for 50-year projection horizons remains below
one or two percent, depending on which sexual mixing scenarios we ascribe to.
Alternative scenarios based on assumptions about changes in sexual norms and
behaviors, consistent with the strong relationship between average income and risky
sexual behavior observed in the CHFLS, produce much larger epidemics. In particular, a
simulated rise in the demand for commercial sex in combination with bi-monthly contacts
with prostitutes will produce an explosive epidemic, but could be prevented by means of
an effective policy intervention promoting 100% condom use with prostitutes.