Abstract
<title>Abstract</title> <p>HIV/AIDS transmission in China has shifted from blood-borne to sexual routes, yet long-term national trends and socioeconomic determinants remain underexplored. This study analyzed HIV/AIDS incidence and mortality in mainland China from 2004 to 2020, using Joinpoint regression to assess temporal trends, global and local Moran’s I statistics to evaluate spatial clustering, age-period-cohort modeling to examine population effects, and principal component analysis combined with geographically and temporally weighted regression (GTWR) to assess spatial-temporal heterogeneity of socioeconomic factors. Age-standardized incidence and mortality rates increased significantly (estimated annual percentage change (EAPC): 19.28% and 21.37%, respectively), with faster growth among males and individuals aged 50–75 years. High-high spatial clusters were observed in Southwest China, while North and East China exhibited low-low clusters. Education emerged as the dominant socioeconomic driver, showing substantial spatial-temporal variation, and approximately 3,000 new infections occurred annually among students aged 0–20, indicating an emerging high-risk group. These findings provide robust evidence for understanding epidemic patterns and underlying drivers of HIV/AIDS at the national level.</p>