Migration Stress, Poor Mental Health, and Engagement in Sex with High-Risk Partners: A Mediation Modeling Analysis of Data from Rural-to-Urban Migrants in China.

Background: There is a growing need for better understanding of mechanisms underpinning the relationship between migration stress and HIV risk behaviors for the development of HIV prevention and control policy.

Methods: Survey data from a random sample of 1,293 Chinese rural-to-urban migrants were analyzed. Stress was assessed using the Domestic Migration Stress Questionnaire (DMSQ), mental health status was assessed using the Brief Symptoms Inventory (BSI), and having sex with high risk partners was assessed as if ever have had sex with high risk partners (e.g., sex workers, intravenous injection drug users, blood donors, persons infected with HIV, persons with sexually transmitted infection, and same gender partners) in the past year. The proposed relationship was tested using mediation modeling method.

Results: Among the sample, 5.5% reported having had sex with high-risk partners in the past year. Mediation analysis indicated that the relationship between DMSQ scores and having sex with high-risk partners was mediated by BSI (coefficient =0.41, 95% CI [0.21, 0.65]), including its components of somatization (0.32 [0.15, 0.53]), obsessive-compulsive disorder (0.31 [0.07, 0.55]), depression (0.45 [0.23, 0.72]), anxiety (0.41 [0.23, 0.63]), and hostility (0.35 [0.17, 0.56]). Furthermore, the effect was more pronounced in males than in females.

Conclusion: The study findings provide new data advancing our understanding of the mechanism of engagement in risky sex, underscoring the need for the HIV prevention policies in China to pay more attention to mental health of the rural-to-urban migrant population.