To examine whether there are any differences in the rates of HIV-spousal transmission between those who have acquired the virus through blood or through sex in central China. A total of 650 HIV-infected individuals were enrolled, 420 of them were either former commercial plasma donors or recipients of blood (blood transmission group [BTG]), and 230 had acquired HIV infection through sex (sex transmission group [STG]). The spousal transmission rate of HIV was 2% per year (94/420, 11.2 years) in BTG and 8.9% per year (115/230, 5.6 years) in STG. There was a significantly higher transmission rate of HIV through male-to-female (11.7% per year, 84/128, 5.6 years) than through female-to-male (5.4% per year, 31/102, 5.6 years, P<0.05) in STG, but there was no significant gender based differences in BTG. In BTG, all HIV-1 tested were subtype B', while in STG, HIV-1 tested were predominantly subtypes CRF01_AE or CRF07_BC. Our results show that the HIV-spousal transmission rate was higher in STG than in BTG, and that there was a higher rate through male-to-female than female-to-male in STG.