Gender Differences in the Association Between Sexual Orientation and Risky Sexual Behavior Among College Students With Sexual Experience in Sichuan Province, Chinese

Abstract

Background Limited information is available regarding risky sexual behavior among college students with different sexual orientations. Aim The aim of this study was to examine the gender differences in the association between sexual orientation and risky sexual behavior among Chinese college students with sexual experience. Methods With a self-assessment questionnaire, we conducted a cross-sectional survey among 73,800 students from 25 vocational colleges (3-year colleges) in the Sichuan province of China. Multivariate logistic regression models were used to examine the association between sexual orientation and risky sexual behavior among students with sexual experience. Outcomes The main outcome measures used regarding risky sexual behavior are the following: condom use in the last sexual intercourse, early sexual debut, and having multiple sexual partners. Results 12,711 students with sexual experience were included. Sexual minority students were more likely to have an early sexual debut (For male students, homosexual: OR = 1.88, P < .001; bisexual: OR = 1.96, P < .001; unsure: OR = 1.68, P < .001. For female students, homosexual: OR = 1.87, P < .01; bisexual: OR = 2.07, P < .01; unsure: OR = 1.53, P < .05), and less likely to use condoms in their last sexual intercourse (except for homosexual male students) (For male students, bisexual: OR = 0.65, P < .01; unsure: OR = 0.60, P < .001. For female students, homosexual: OR = 0.21, P < .001; bisexual: OR = 0.54, P < .001; unsure: OR = 0.68, tP < .05). There are gender differences in the association between sexual orientation and having multiple sexual partners. Male sexual minorities were more likely to have multiple sexual partners than heterosexual students (homosexual: OR = 2.06, P < .001; bisexual: OR = 1.66, P < .001; unsure: OR = 1.31, P < .05), while the same result was only observed in bisexual female students (OR = 1.46, P < .01). Clinical Implications Sexual health education professionals should consider the sexual orientation of students when providing counseling services or educational intervention, especially for male students and LGBT ones. Strengths & Limitations We examined gender differences in the association between sexual orientation and risky sexual behavior among college students with sexual experience. However, the ability for the cross-sectional survey to address causality is limited, and will be further tested in cohort studies. Conclusion Gender and sexual orientation affect the likelihood of risky sexual behavior among China's college students, and gender differences in the association between sexual orientation and risky sexual behavior should be noticed.