Potential HIV transmission risk among spouses: marriage intention and expected extramarital male-to-male sex among single men who have sex with men in Hunan, China

Abstract

ObjectiveThe HIV epidemic in China is shifting from the high-risk groups of men who have sex with men (MSM), injection drug users and sex workers to the general population, and sexual contact among spouses is assumed to be one route of transmission. Our objective was to determine the intention to marry and the expected extramarital male-to-male sex among single Chinese MSM, in order to estimate the potential HIV transmission risk among MSM living with HIV and their female spouses.MethodsWe conducted a web-based, cross-sectional survey between May 2016 and May 2017. A questionnaire covering sociodemographic characteristics, sexual behaviours, HIV-related and homosexuality-related stigma, marriage intention, and expected extramarital sexual behaviours was completed by 556 single MSM in Hunan, China. Descriptive statistics, χ2 test, two-sample t-test and multivariate logistic regression analysis were performed.ResultsCurrently 48.9% of the participants intended to marry a woman in their lifetime, and 91% of them reported that they would continue to have sex with men after getting married. Those who were living with parents (OR=2.26), self-identified as bisexual (OR=2.57), had at least one heterosexual partner in the previous 6 months (OR=0.33) and perceived a higher level of self-homosexual stigma (OR=1.78) had greater intention to marry a woman.ConclusionNearly half of Chinese MSM intend to marry women, which has significantly dropped from the estimated percentage more than 10 years ago for Chinese MSM. However, the expectation of extramarital homosexual behaviours was common in these men. Sexual and gender minority stresses especially from family members, homosexual identity assertiveness and related stigma were the main factors for marriage intention, which should be addressed in future studies and practices.

AIDS-Related Behavioral Characteristics of Men Who Have Sex with Men in Chongqing, China

“…This study found that the majority of MSM were unmarried, which is consistent with the previous studies [8,10,14,27,30]. The first reason may be that same-sex marriage is not recognized by the law and the secular in China [28], while some studies have found that attitudes towards sex and gender diversity have become more tolerant in China, and more MSM will remain single or live with gay partners [29]. Second, some people hold the belief that not getting married is responsible for themselves and will not cause harm to female partners [31].…”

“…In this study, MSM is mainly young people, which is similar to the research results of many literatures [8,10,13,14,[27][28][29]. Qin et al [7] found that most HIV infection cases in China occurred in MSM aged 20-39, which indicates that HIV may be more prevalent among young MSM population in the sexually active period [13].…”

“…In addition, the results also observed that 20.0% of MSM have been married, which is similar to the results of a cross-sectional survey from China [10]. Forced by social responsibility, and Chinese traditional culture (filial piety) or values (inheritance of family blood), the resulting family pressure (marriage and birth) and the protection of homosexuality from discrimination and stigmatization [10,11,14,28,29,31], some MSM may choose to get marriage with women [28,29,32].…”

“…More than half of MSM with fixed female partners reported that they had not used condoms in every sexual act in the past three months. This study also found that MSM had more unprotected sexual behaviors with female partners than with men, probably because of family pressure or personal desire to have children of their own blood [14,29], or fear that the use of condoms will lead to distrust of their female partners, or lack of awareness of their own risks [14]. It is worth noting that MSM with bisexual behavior can become a bridge for transmitting HIV to the general female population [8,9,11,39].…”

Correlates of HIV Testing Frequency in MSM Based on a Survey from 2011-2018: A Hint for Risk Reduction Strategy

“…The results of this study indicate that the annual testing behavior of married MSM is not as good as that of single MSM. A study in China showed that under parental or social pressure, nearly half (48.9%) of men who had sex with men chose to marry women, and 91% of them reported that they would practice homosexual behavior after marriage [19]. This behavior may expand the spread of HIV from MSM to the general population or the next generation.…”