High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy

Claire Liu

doi:doi:10.11648/j.ijidt.20251003.11

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High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy

Claire Liu^*

Published in International Journal of Infectious Diseases and Therapy (Volume 10, Issue 3)

Received: 14 July 2025 Accepted: 24 July 2025 Published: 8 August 2025

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Abstract

My medical missionary trip to Xinjie Village in the summer of 2024 and 2025 revealed a devastating public health crisis: an HIV rate of 11%, shockingly 100 times China’s national average. Located in Liangshan Yi Autonomous Prefecture, Sichuan, Xinjie is home to the Yi ethnic group, whose unique cultural practices, geographic isolation, and socioeconomic marginalization have fueled one of the worst HIV outbreaks in China. The Yi practice "walking marriage," a matrilineal system where men and women maintain separate households, leading to transient sexual partnerships and low contraceptive use, which are key drivers of HIV spread. Compounding this risk, Tibetan Buddhist beliefs frame childbirth as sacred, discouraging condom use, while proximity to the Golden Triangle drug-trafficking route has introduced high rates of injection drug use and needle-sharing. Additionally, extreme educational deprivation, with only 4% of villagers having completed high school, perpetuates misinformation, with many attributing HIV to ancestral curses rather than viral spread. This article examines the intersecting factors sustaining Xinjie’s outbreak: (1) sexual networks from walking marriage, fostering overlapping partnerships; (2) drug trafficking exposure, with needle-sharing amplifying blood-borne spread; and (3) educational deficits, leaving villagers unaware of prevention or treatment. Culturally insensitive policies and a lack of healthcare infrastructure further aggravate the crisis. Effective intervention requires harm reduction (e.g., needle exchanges, PrEP), culturally adapted sexual health education, and investment in bilingual schooling to combat health illiteracy. Xinjie’s plight underscores the urgent need for integrated, fairness-focused approaches in marginalized communities globally. Without addressing these structural and cultural determinants, HIV will continue its unchecked spread, leaving generations at risk.

Published in	International Journal of Infectious Diseases and Therapy (Volume 10, Issue 3)
DOI	10.11648/j.ijidt.20251003.11
Page(s)	56-61
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

HIV/AIDS, Ethnic Minorities, China, Sexual Networks, Injection Drug Use, Health Disparities

1. Introduction

At the southwestern corner of Liangshan Autonomous Prefecture in Sichuan Province, China, there are a number of scattered aboriginal villages of the Yi ethnic group. Unlike the Han Chinese

[1]

, who are the dominant ethnic group in China, the Yi people have maintained their own unique culture for thousands of years, and one of their characteristics is "walking marriage." "Walking marriage" implies that there is no formal marriage between the men and women. Each man and woman continues to live in their original home throughout their life. If a woman becomes pregnant, since it may be difficult to determine the father, the child will be raised by the entire tribe after he or she is born. To this day, only a handful of villages in China still maintain this duolocal marriage system in a so-called matrilineal society, and Xinjie Village

[2]

is one of them. I had the opportunity to go on a medical mission to this village in the summer of 2024 and 2025, and just as striking as the marriage system is the astonishingly high prevalence of human immunodeficiency virus (HIV) in this village, which is 11%, dramatically 100 times the overall prevalence of HIV in China and 55 times more than the prevalence of Sichuan Province as a whole, which was 0.2% in 2020

[3]

. There are 389 residents in Xinjie village, and 41 of whom have been diagnosed with HIV.

In the absence of marital bonding, both men and women have a tendency for more sexual partners, while HIV incidence is directly proportional to the number of sexual partners, regardless of same-sex or opposite-sex sexual relationships

[4]

. The Yi people believe in Tibetan Buddhism, which suggests that children are reincarnated from the souls of their deceased ancestors; thus, the birth of a new child into any family is a joyous blessing for the entire tribe. As a result, men and women in this village generally avoid contraception when having sex, which has long been a breeding ground for HIV infection. In addition, Liangshan Autonomous Prefecture is geographically fairly close to the Golden Triangle

[5]

region, which borders Thailand, Myanmar, and Laos and is renowned as the largest opium-producing area worldwide

[14]

; hence, the Xinjie villagers have a higher probability of exposure to drugs, for Liangshan is actually the first point of entry into China for drugs smuggled from the Golden Triangle

[5]

, especially intravenous heroin use. Similar to other parts of the world where intravenous drug use is prevalent, HIV can be contracted through the sharing of needles

[6]

. Moreover, the Yi tribes lack educational resources. The average education level of the Xinjie villagers is elementary school, and only 16 residents have completed high school, and there is not a single college in the entire Liangshan Autonomous Prefecture. Therefore, the poor health literacy among the villagers may indirectly contribute to the rapid spread of HIV, given that they likely do not possess knowledge for the nature of HIV and the routes for spread.

2. Factors That Potentially Increase the HIV Prevalence

Three different factors can plausibly contribute to the HIV pandemic in Xinjie village:

1) Sexual networks and low contraceptive use.

2) Proximity to drug trafficking routes

[7]

as the multifaceted driver of HIV transmission.

3) Educational disparities as a fundamental driver of health inequities.

2.1. Sexual Networks and Low Contraceptive Use

The walking marriage (走婚, zǒu hūn) system, a cornerstone of Yi society in Xinjie Village

[2]

, creates a unique sexual network structure that diverges sharply from monogamous norms prevalent in Han Chinese communities

[8]

. In this system, men and women maintain lifelong residence in their natal households, engaging in non-cohabitative partnerships that are often transient and fluid. Unlike formal marriages, which typically enforce exclusive partnerships, the absence of formal marriages in walking marriages fosters concurrent sexual partnerships with overlapping connections across the community. Such networks are well-documented amplifiers of sexually transmitted infection (STI) spread, as they increase the likelihood of bridge populations (individuals who link otherwise disconnected clusters), facilitating rapid pathogen spread

[9]

. Mathematical modeling of similar high-partner-turnover societies (e.g., certain polyamorous or serially monogamous groups) suggests that HIV spread rates scale exponentially with the number of overlapping partnerships, particularly in the absence of barrier protection

[10]

Compounding this structural risk is the religious and cultural value of fertility rooted in Tibetan Buddhist traditions observed by the Yi. Central to their belief system is the concept that children are reincarnations of ancestral souls, making every birth a sacred event that strengthens the tribe’s spiritual continuity. Consequently, contraceptive use is stigmatized as interference with divine will, and community elders often discourage modern family planning methods. Interviews with local health workers during the 2024 medical mission revealed that <10% of sexually active villagers reported consistent condom use, with many citing fear of "disrupting fate" or displeasing ancestors. This aligns with global studies demonstrating that religiosity-linked opposition to contraception (e.g., in Catholic-majority or pro-birth communities) correlates with elevated STI incidence

[11]

The synergy between multi-partner sexual networks and low contraceptive uptake creates a perilous feedback loop: frequent partner exchange without prophylaxis dramatically increases the probability of HIV introduction into new subpopulations, while the lack of prenatal STI screening (due to limited healthcare access) allows vertical mother-to-child spread to go unchecked

[4]

. Notably, Xinjie’s HIV prevalence is disproportionately high among women of reproductive age (15–49 years), suggesting that perinatal spread may further sustain the outbreak. Qualitative data from village focus groups highlight that pregnancy is rarely planned, and prenatal care, including HIV testing, is often sought only after visible symptoms emerge. Moreover, the gendered dynamics of walking marriage may worsen vulnerabilities. While men historically bear no formal responsibility for child-rearing, women face connectional stigma if they seek STI testing or refuse unprotected sex, as their societal role is tied to motherhood. This mirrors challenges observed in other matrilineal-but-patriarchal societies (e.g., parts of Papua New Guinea), where women’s autonomy over sexual health decisions is constrained by communal expectations

[12]

Geographically structural barriers further impede intervention efficacy. The nearest clinic stocking pre-exposure prophylaxis (PrEP) or offering antiretroviral therapy (ART) is more than 50 kilometers away, and health outreach programs rarely address culturally embedded resistance to condoms. A 2023 pilot study in Liangshan found that traditional healers, who are more trusted than biomedical providers, often conflate HIV with "ancestral curses," delaying allopathic care-seeking

[13]

In brief, Xinjie’s HIV outbreak is biologically fueled by high-partner-turnover networks and culturally entrenched by pro-birth beliefs, with structural inequities perpetuating spread. Tailored interventions must integrate ethnographic engagement (e.g., collaborating with village shamans to reinterpret condom use as "ancestor-approved protection") and decentralized HIV services (e.g., mobile ART units). Without addressing these intertwined factors, the cycle of spread will relentlessly persist.

2.2. Proximity to Drug Trafficking Routes: A Multifaceted Driver of HIV Transmission

The Liangshan Yi Autonomous Prefecture occupies a geographically and politically strategic position as a critical transit hub along China's southwestern border, placing it within the sphere of influence of the notorious Golden Triangle

[5]

: the tri-border region encompassing northern Thailand, Myanmar's Shan State, and Laos that accounts for approximately 40% of global illicit opium production and 70% of Southeast Asia's methamphetamine supply

[14]

. This proximity to one of the world's most prolific drug-producing regions has transformed Liangshan into what international narcotics control agencies describe as "China's first line of defense" against drug smuggling, with intercepted shipments indicating that over 60% of heroin entering China from Myanmar transits through Liangshan's mountainous terrain

[15]

. The prefecture's rugged topography, characterized by dense forests, poorly patrolled mountain passes, and a sparse population, creates an ideal environment for clandestine drug trafficking operations, which are frequently controlled by armed ethnic militias with cross-border ties to organized crime syndicates in the Golden Triangle

[5]

The influx of cheap, high-purity heroin into Liangshan has fueled an outbreak of injection drug use that public health authorities have struggled to contain. Epidemiological surveys conducted between 2020-2024 estimate that nearly 8% of Liangshan's adult male population engages in regular intravenous heroin use, with rates exceeding 15% in border townships adjacent to major trafficking corridors

[16]

. Among people who inject drugs (PWID) in Xinjie Village

[2]

, needle-sharing behaviors are alarmingly common, with qualitative interviews revealing that over 75% of PWID report sharing syringes within the past month, a practice driven by scarcity of sterile equipment, lack of harm reduction knowledge, and the social rituals surrounding communal drug preparation. This has created a perfect storm for bloodborne pathogen spread, with molecular surveillance data showing that HIV-1 CRF07_BC and CRF08_BC, recombinant strains strongly associated with injection drug use outbreaks in Asia, accounting for over 90% of local HIV cases

[17]

Compounding the biological risk factors are structural vulnerabilities rooted in Liangshan's socioeconomic marginalization. The region's status as an ethnic autonomous prefecture has historically translated into limited infrastructure investment from central government authorities, resulting in sparse addiction treatment facilities, as there is only one methadone maintenance therapy (MMT) clinic serving Liangshan's 5 million residents, located over 200 km from Xinjie Village

[2]

. Furthermore, China's strict punitive drug policies have created a climate of fear that drives PWID underground (Human Rights Watch, 2009); police crackdowns under the "Strike Hard" anti-drug campaign have led to mass incarcerations but done little to reduce demand, while compulsory detoxification centers often lack basic medical services. This policy environment has severely hampered the implementation of evidence-based harm reduction strategies such as needle exchange programs remain officially prohibited in Sichuan Province, and PrEP outreach to PWID is virtually nonexistent.

The connection of drug use and sexual spread networks further worsens the crisis. Ethnographic research documents that over 30% of female PWID in Xinjie engage in transactional sex to fund their drug habits, often with migrant workers and long-haul truck drivers who traverse the drug trafficking routes

[7]

. This creates bridging populations that connect high-risk PWID networks with the general community, facilitating dual HIV spread dynamics, both through needle-sharing clusters and subsequent sexual spread to non-injecting partners. Molecular epidemiological studies have identified identical HIV viral sequences in both PWID and their sexual partners, confirming this two-way spread

[18]

. Economic desperation perpetuates the cycle, as the collapse of traditional livelihoods has made drug trafficking an attractive option for impoverished Yi youth. With unemployment rates exceeding 40% in some Liangshan counties, many young men are recruited as low-level drug couriers ("mules") by trafficking rings, receiving payment in heroin rather than cash, a practice that ensures a steady pipeline of new injectors. The stigmatization of PWID then creates additional barriers to healthcare access, as many avoid clinics due to fears of mandatory drug testing and police notification.

Addressing this crisis requires multiple interventions that go beyond traditional HIV prevention paradigms. Potential strategies include:

1) Pilot syringe exchange programs with discreet mobile distribution in trafficking hotspots

2) Integration of HIV services into existing MMT programs with expanded clinic locations

3) Community-based outreach employing former PWID as peer educators

4) Alternative development programs to reduce economic reliance on the drug trade

5) Police training on public health approaches to drug use

6) Decentralized ART distribution through village health stations

Without such comprehensive measures, Liangshan's status as both a drug trafficking corridor and HIV epicenter will continue to reinforce one another, with Xinjie Village

[2]

serving as a microcosm of this devastating synergy.

2.3. Educational Disparities: A Fundamental Driver of Health Inequities in Xinjie Village

The extreme educational deprivation observed in Xinjie Village

[2]

represents one of the most profound structural determinants of health vulnerability in this marginalized community. Census data collected during the 2024 medical mission revealed that only 16 out of 389 residents (4.1%) had completed secondary education, while not a single villager had progressed to tertiary education, a statistic that stands in stark contrast to China's national high school completion rate of 92.7%

[19]

and the 58.3% college enrollment rate among urban youth

[19]

. This educational chasm manifests across multiple dimensions of village life, beginning with basic literacy challenges, approximately 63% of adult villagers (ages 18-65) demonstrate functional literacy levels below Grade 3 standards, rendering them unable to comprehend basic healthcare instructions or medication labels. The situation is particularly dire for women over 40, among whom illiteracy rates approach 85%, creating gendered barriers to health information access that mirror patterns seen in other patriarchal, pastoral communities globally.

The roots of this educational crisis are multigenerational and systemic. Xinjie's sole primary school, a three-room concrete structure built in 1998, has never had more than two certified teachers simultaneously, both of whom must manage multigrade classrooms with students ranging from ages 6 to 14. Teacher retention rates are abysmal, with 100% turnover every 2-3 years as urban-educated instructors quickly transfer out of the remote post. Compounding this, the Yi-language instruction used in early grades creates a linguistic barrier when students transition to Mandarin-dominated secondary curricula, a phenomenon documented by UNESCO as the "bilingual education bottleneck" that disproportionately impacts ethnic minority regions

[20]

. Economic pressures further truncate educational trajectories, with over 70% of students dropping out by age 13 to assist in subsistence farming or seasonal migrant work, perpetuating a cycle where less-educated parents undervalue schooling for their children.

The health literacy consequences are catastrophic. Standardized assessments administered via questionnaires to all the resident in the Xinjie village during my medical mission in 2024-25 revealed that only 11% of villagers could correctly identify all three major HIV spread routes, 28% believed HIV could spread through mosquito bites or shared meals, 62% were unaware that ART exists, and 91% had never heard of PrEP. These knowledge gaps directly facilitate HIV spread through multiple pathways:

1) Prevention misinformation: Condoms are frequently perceived as "only for birth control" rather than disease prevention

2) Testing avoidance: Fatalistic attitudes prevail, with many believing "testing positive means immediate death"

3) Treatment non-adherence: ART regimens are often abandoned when side effects emerge due to lack of counseling

4) Intergenerational spread: Mothers without prevention knowledge have 35% higher rates of vertical HIV spread

The connection with cultural belief systems worsens these gaps. Traditional Yi cosmology interprets illness through supernatural frameworks where 38% of villagers in focus groups attributed HIV to "ancestral punishment" rather than viral spread

[21]

, leading to preferential use of shamanic rituals over biomedical care. This mixing of beliefs creates particular challenges for public health messaging, as Western medical concepts must be in terms of language and thinking translated to resonate with native worldviews.

Urban-rural disparities in educational infrastructure investment further entrench the problem. While Shanghai spends ￥42,000 per student annually, Liangshan's per-student expenditure barely reaches ￥3,800, with Xinjie Village receiving even less due to its remote location. The nearest secondary school is a 4-hour mountain trek away, with no boarding facilities, making daily attendance physically impossible for most children. Digital education initiatives have completely bypassed the village for 0% of households have reliable internet access, and the community lacks even a single computer. Breaking this cycle hence requires many-sided interventions

[22]

1) Culturally adapted HIV education: Developing Yi-language curricula that integrate biomedical and traditional knowledge systems

2) Mobile school programs: Bringing certified teachers to remote villages through rotating "circuit teacher" systems

3) Mother-focused literacy programs: Targeting women's education to improve family health decision-making

4) School-based health clinics: Combining basic education with on-site sexual health services

5) Incentive structures: Providing rice subsidies or cash transfers for school attendance

6) Peer educator networks: Training literate villagers as community health ambassadors

Without addressing these foundational educational deficits, even the most advanced biomedical HIV interventions will fail to achieve sustainable impact in Xinjie. The village's plight underscores the critical nexus between education policy and outbreak control—a lesson with global relevance for marginalized populations worldwide.

3. Conclusion

The HIV outbreak in Xinjie Village

[2]

, with its staggering rate of 11%, stands as a stark example of how cultural traditions, structural vulnerabilities, and socioeconomic disparities converge to create a perfect storm for disease spread. The matrilineal walking marriage system, while culturally significant, fosters complex sexual networks with overlapping partnerships and minimal contraceptive use, facilitating rapid HIV spread. Compounding this risk are deeply rooted pro-birth beliefs tied to Tibetan Buddhism, which discourage condom use and frame childbirth as a sacred duty, further increasing exposure to infection. Meanwhile, the village’s geographic proximity to drug trafficking routes

[7]

from the Golden Triangle

[5]

has introduced high rates of injection drug use and needle-sharing, another major vector for HIV spread. These factors are worsened by extreme educational deprivation, where low literacy rates, misinformation about HIV, and limited access to healthcare perpetuate the cycle of infection.

Addressing this crisis demands more than conventional public health interventions; it requires a culturally nuanced, multi-sectoral approach that respects local traditions while implementing evidence-based solutions. First, harm reduction strategies, such as needle exchange programs and expanded access to methadone maintenance therapy, must be introduced to mitigate risks among PWID. However, these measures must be paired with efforts to dismantle the stigma surrounding drug use, possibly through community-led education and the involvement of trusted local figures, such as shamans or village elders. Second, sexual health initiatives must move beyond generic condom distribution and instead engage with Yi cultural frameworks, perhaps reframing HIV prevention as a means of protecting future generations rather than challenging ancestral beliefs. Integrating biomedical messaging with traditional narratives could enhance acceptance and adherence.

Education remains the most critical long-term intervention. Xinjie’s abysmal literacy rates and lack of schooling infrastructure perpetuate health illiteracy, leaving villagers unaware of basic HIV spread mechanisms or treatment options. Sustainable solutions should include mobile schools, bilingual (Yi and Mandarin) health curricula, and incentives for teacher retention in remote areas. Additionally, women who bear the greatest burden of HIV in Xinjie due to gendered healthcare disparities must be prioritized through targeted literacy programs and maternal health services.

Beyond Xinjie, this case study highlights a broader global challenge: marginalized ethnic communities often face disproportionate disease burdens due to intersecting structural inequities. Policies must shift from punitive measures (such as China’s strict drug crackdowns) to holistic, fairness-focused approaches that address root causes rather than symptoms. International collaboration, drawing on lessons from other native populations battling HIV, could provide valuable frameworks for intervention.

Ultimately, without systemic changes that integrate cultural sensitivity, harm reduction, education, and healthcare access, Xinjie’s HIV crisis will persist. The village serves as both a warning and an opportunity, a reminder of how neglect and marginalization fuel outbreaks, but also a test case for how innovative, community-driven solutions can break the cycle of spread. The time for action is now, not only to save Xinjie but to forge a model for health justice in similarly vulnerable communities worldwide.

Abbreviations

ART	Antiretroviral Therapy
HIV	Human Immunodeficiency Virus
MMT	Methadone Maintenance Therapy
PrEP	Pre-Exposure Prophylaxis
PWID	People Who Inject Drugs
STI	Sexually Transmitted Infection

Acknowledgments

Dr. Javier Morales Castillo and Dr. Élise Dubois-Lefèvre from my medical missionary team provided guidance and supervision on the format and content of this article, reviewed the manuscript, and suggested corrections.

Author Contributions

Claire Liu is the sole author. The author read and approved the final manuscript.

Funding

This work is not supported by any external funding.

Conflicts of Interest

The author declares no conflicts of interest.

References

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[2]	Wang, H., et al. (2015). Evaluation of the effectiveness of methadone maintenance treatment on HIV prevention among drug users in Liangshan Prefecture, China. PloS one, 10(7), e0132043.
[3]	China CDC. (2020). National HIV prevalence report. Chinese Center for Disease Control and Prevention. Human Rights Watch. (2009). China's hidden epidemic: Discrimination against people with HIV/AIDS. Human Rights Watch.
[4]	UNAIDS. (2023). Global HIV statistics. Joint United Nations Programme on HIV/AIDS.
[5]	Lintner, B. (2002). Blood brothers: Crime, business and the secret societies of Asia. Allen & Unwin.
[6]	Mathers, B. M., et al. (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet, 372(9651), 1733-1745.
[7]	Shen, C., et al. (2017). Sexual risk behaviors and HIV prevalence among female drug users in Sichuan, China. Drug and alcohol dependence, 179, 297-303.
[8]	Yan, Y. (2000). Private life under socialism: Love, intimacy, and family change in a Chinese village, 1949-1999. Stanford University Press.
[9]	Morris, M. (1993). Epidemiology and social network modeling: Progress and pitfalls. Sociological methods & research, 22(1), 115-142.
[10]	Anderson, R. M., & May, R. M. (1991). Infectious diseases of humans: Dynamics and control. Oxford university press.
[11]	Blanc, A. K. (2001). The effect of power in sexual relationships on sexual and reproductive health: an update.
[12]	Jenkins, C. L., et al. (1990). Patterns of sexual behavior and perceptions of AIDS in Papua New Guinea. AIDS, 4(11), 1129-1131.
[13]	Chen, J., et al. (2023). Title of the study on traditional healers and HIV. [Unpublished manuscript].
[14]	United Nations Office on Drugs and Crime. (2023). World drug report 2023. United Nations.
[15]	Zhou, Y., et al. (2016). Drug trafficking and HIV transmission in Southwestern China. International Journal of Offender Therapy and Comparative Criminology, 60(4), 458-476.
[16]	Li, X., & Stanton, B. (2019). HIV/AIDS knowledge, attitudes, and behaviors among rural Chinese injecting drug users. International journal of STD & AIDS, 30(1), 64-72.
[17]	Zhang, L., et al. (2018). Molecular characterization and transmission dynamics of HIV-1 in Liangshan Prefecture, China. PloS one, 13(3), e0194725.
[18]	Smith, K. R., et al. (2020). Molecular epidemiology of HIV transmission between people who inject drugs and their sexual partners. AIDS, 34(8), 1189-1198.
[19]	Ministry of Education. (2023). National education statistics bulletin. Ministry of Education of the People's Republic of China.
[20]	UNESCO. Title of the report on bilingual education. United Nations Educational, Scientific and Cultural Organization.
[21]	Yang, F., et al. (2019). Health Literacy and HIV Knowledge Among Rural Yi Villagers in Sichuan, China. Health Education Research, 34(1), 67-78.
[22]	Morales Castillo, J., & Dubois-Lefèvre, Élise. (2024). Supervision and Guidance on the HIV Prevalence in a Matrilineal Yi Community in China. International Journal of Community Health and Education.

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Liu, C. (2025). High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy. International Journal of Infectious Diseases and Therapy, 10(3), 56-61. https://doi.org/10.11648/j.ijidt.20251003.11

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Liu, C. High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy. Int. J. Infect. Dis. Ther. 2025, 10(3), 56-61. doi: 10.11648/j.ijidt.20251003.11

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Liu C. High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy. Int J Infect Dis Ther. 2025;10(3):56-61. doi: 10.11648/j.ijidt.20251003.11

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@article{10.11648/j.ijidt.20251003.11,
  author = {Claire Liu},
  title = {High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy
},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {10},
  number = {3},
  pages = {56-61},
  doi = {10.11648/j.ijidt.20251003.11},
  url = {https://doi.org/10.11648/j.ijidt.20251003.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20251003.11},
  abstract = {My medical missionary trip to Xinjie Village in the summer of 2024 and 2025 revealed a devastating public health crisis: an HIV rate of 11%, shockingly 100 times China’s national average. Located in Liangshan Yi Autonomous Prefecture, Sichuan, Xinjie is home to the Yi ethnic group, whose unique cultural practices, geographic isolation, and socioeconomic marginalization have fueled one of the worst HIV outbreaks in China. The Yi practice "walking marriage," a matrilineal system where men and women maintain separate households, leading to transient sexual partnerships and low contraceptive use, which are key drivers of HIV spread. Compounding this risk, Tibetan Buddhist beliefs frame childbirth as sacred, discouraging condom use, while proximity to the Golden Triangle drug-trafficking route has introduced high rates of injection drug use and needle-sharing. Additionally, extreme educational deprivation, with only 4% of villagers having completed high school, perpetuates misinformation, with many attributing HIV to ancestral curses rather than viral spread. This article examines the intersecting factors sustaining Xinjie’s outbreak: (1) sexual networks from walking marriage, fostering overlapping partnerships; (2) drug trafficking exposure, with needle-sharing amplifying blood-borne spread; and (3) educational deficits, leaving villagers unaware of prevention or treatment. Culturally insensitive policies and a lack of healthcare infrastructure further aggravate the crisis. Effective intervention requires harm reduction (e.g., needle exchanges, PrEP), culturally adapted sexual health education, and investment in bilingual schooling to combat health illiteracy. Xinjie’s plight underscores the urgent need for integrated, fairness-focused approaches in marginalized communities globally. Without addressing these structural and cultural determinants, HIV will continue its unchecked spread, leaving generations at risk.},
 year = {2025}
}

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AB  - My medical missionary trip to Xinjie Village in the summer of 2024 and 2025 revealed a devastating public health crisis: an HIV rate of 11%, shockingly 100 times China’s national average. Located in Liangshan Yi Autonomous Prefecture, Sichuan, Xinjie is home to the Yi ethnic group, whose unique cultural practices, geographic isolation, and socioeconomic marginalization have fueled one of the worst HIV outbreaks in China. The Yi practice "walking marriage," a matrilineal system where men and women maintain separate households, leading to transient sexual partnerships and low contraceptive use, which are key drivers of HIV spread. Compounding this risk, Tibetan Buddhist beliefs frame childbirth as sacred, discouraging condom use, while proximity to the Golden Triangle drug-trafficking route has introduced high rates of injection drug use and needle-sharing. Additionally, extreme educational deprivation, with only 4% of villagers having completed high school, perpetuates misinformation, with many attributing HIV to ancestral curses rather than viral spread. This article examines the intersecting factors sustaining Xinjie’s outbreak: (1) sexual networks from walking marriage, fostering overlapping partnerships; (2) drug trafficking exposure, with needle-sharing amplifying blood-borne spread; and (3) educational deficits, leaving villagers unaware of prevention or treatment. Culturally insensitive policies and a lack of healthcare infrastructure further aggravate the crisis. Effective intervention requires harm reduction (e.g., needle exchanges, PrEP), culturally adapted sexual health education, and investment in bilingual schooling to combat health illiteracy. Xinjie’s plight underscores the urgent need for integrated, fairness-focused approaches in marginalized communities globally. Without addressing these structural and cultural determinants, HIV will continue its unchecked spread, leaving generations at risk.
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Claire Liu

International Baccalaureate Division, St. John’s School, Tamuning, Guam

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http://orcid.org/0009-0005-4160-5481

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Liu, C. (2025). High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy. International Journal of Infectious Diseases and Therapy, 10(3), 56-61. https://doi.org/10.11648/j.ijidt.20251003.11

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Liu, C. High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy. Int. J. Infect. Dis. Ther. 2025, 10(3), 56-61. doi: 10.11648/j.ijidt.20251003.11

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Liu C. High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy. Int J Infect Dis Ther. 2025;10(3):56-61. doi: 10.11648/j.ijidt.20251003.11

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@article{10.11648/j.ijidt.20251003.11,
  author = {Claire Liu},
  title = {High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy
},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {10},
  number = {3},
  pages = {56-61},
  doi = {10.11648/j.ijidt.20251003.11},
  url = {https://doi.org/10.11648/j.ijidt.20251003.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20251003.11},
  abstract = {My medical missionary trip to Xinjie Village in the summer of 2024 and 2025 revealed a devastating public health crisis: an HIV rate of 11%, shockingly 100 times China’s national average. Located in Liangshan Yi Autonomous Prefecture, Sichuan, Xinjie is home to the Yi ethnic group, whose unique cultural practices, geographic isolation, and socioeconomic marginalization have fueled one of the worst HIV outbreaks in China. The Yi practice "walking marriage," a matrilineal system where men and women maintain separate households, leading to transient sexual partnerships and low contraceptive use, which are key drivers of HIV spread. Compounding this risk, Tibetan Buddhist beliefs frame childbirth as sacred, discouraging condom use, while proximity to the Golden Triangle drug-trafficking route has introduced high rates of injection drug use and needle-sharing. Additionally, extreme educational deprivation, with only 4% of villagers having completed high school, perpetuates misinformation, with many attributing HIV to ancestral curses rather than viral spread. This article examines the intersecting factors sustaining Xinjie’s outbreak: (1) sexual networks from walking marriage, fostering overlapping partnerships; (2) drug trafficking exposure, with needle-sharing amplifying blood-borne spread; and (3) educational deficits, leaving villagers unaware of prevention or treatment. Culturally insensitive policies and a lack of healthcare infrastructure further aggravate the crisis. Effective intervention requires harm reduction (e.g., needle exchanges, PrEP), culturally adapted sexual health education, and investment in bilingual schooling to combat health illiteracy. Xinjie’s plight underscores the urgent need for integrated, fairness-focused approaches in marginalized communities globally. Without addressing these structural and cultural determinants, HIV will continue its unchecked spread, leaving generations at risk.},
 year = {2025}
}

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TY  - JOUR
T1  - High HIV Prevalence in a Matrilineal Yi Community in China: The Role of Culture, Geography, and Literacy

AU  - Claire Liu
Y1  - 2025/08/08
PY  - 2025
N1  - https://doi.org/10.11648/j.ijidt.20251003.11
DO  - 10.11648/j.ijidt.20251003.11
T2  - International Journal of Infectious Diseases and Therapy
JF  - International Journal of Infectious Diseases and Therapy
JO  - International Journal of Infectious Diseases and Therapy
SP  - 56
EP  - 61
PB  - Science Publishing Group
SN  - 2578-966X
UR  - https://doi.org/10.11648/j.ijidt.20251003.11
AB  - My medical missionary trip to Xinjie Village in the summer of 2024 and 2025 revealed a devastating public health crisis: an HIV rate of 11%, shockingly 100 times China’s national average. Located in Liangshan Yi Autonomous Prefecture, Sichuan, Xinjie is home to the Yi ethnic group, whose unique cultural practices, geographic isolation, and socioeconomic marginalization have fueled one of the worst HIV outbreaks in China. The Yi practice "walking marriage," a matrilineal system where men and women maintain separate households, leading to transient sexual partnerships and low contraceptive use, which are key drivers of HIV spread. Compounding this risk, Tibetan Buddhist beliefs frame childbirth as sacred, discouraging condom use, while proximity to the Golden Triangle drug-trafficking route has introduced high rates of injection drug use and needle-sharing. Additionally, extreme educational deprivation, with only 4% of villagers having completed high school, perpetuates misinformation, with many attributing HIV to ancestral curses rather than viral spread. This article examines the intersecting factors sustaining Xinjie’s outbreak: (1) sexual networks from walking marriage, fostering overlapping partnerships; (2) drug trafficking exposure, with needle-sharing amplifying blood-borne spread; and (3) educational deficits, leaving villagers unaware of prevention or treatment. Culturally insensitive policies and a lack of healthcare infrastructure further aggravate the crisis. Effective intervention requires harm reduction (e.g., needle exchanges, PrEP), culturally adapted sexual health education, and investment in bilingual schooling to combat health illiteracy. Xinjie’s plight underscores the urgent need for integrated, fairness-focused approaches in marginalized communities globally. Without addressing these structural and cultural determinants, HIV will continue its unchecked spread, leaving generations at risk.
VL  - 10
IS  - 3
ER  -

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