Nonstudent Young Men Put Students at High Risk of HIV Acquisition in Guangxi, China: A Phylogenetic Analysis of Surveillance Data

Background We sought to identify students and their sexual partners in a molecular transmission network. Methods We obtained 5996 HIV protease and reverse transcriptase gene sequences in Guangxi (165 from students and 5831 from the general populations) and the relevant demographic data. We constructed a molecular transmission network and introduced a permutation test to assess the robust genetic linkages. We calculated the centrality measures to describe the transmission patterns in clusters. Results At the network level, 68 (41.2%) students fell within the network across 43 (8.1%) clusters. Of 141 genetic linkages between students and their partners, only 25 (17.7%) occurred within students. Students were more likely than random permutations to link to other students (odds ratio [OR], 7.2; P < .001), private company employees aged 16-24 years (OR, 3.3; P = .01), private company or government employees aged 25-49 years (OR, 1.7; P = .03), and freelancers or unemployed individuals aged 16-24 years (OR, 5.0; P < .001). At the cluster level, the median age of nonstudents directly linked to students (interquartile range) was 25 (22-30) years, and 80.3% of them had a high school or higher education background. Compared with students, they showed a significantly higher median degree (4.0 vs 2.0; P < .001) but an equivalent median Eigenvector Centrality (0.83 vs 0.81; P = .60). Conclusions The tendency of genetic linkage between students and nonstudent young men and their important position in the HIV transmission network emphasizes the urgent need for 2-pronged public health interventions based on both school and society.