Trends in high-risk sexual behaviors among general population groups in China: a systematic review

Abstract

Background: The objective of this review was to investigate whether Chinese population groups that do not belong to classical high risk groups show an increasing trend of engaging in high-risk sexual behaviors.

Methods: We systematically searched the English and Chinese literature on sexual risk behaviors published between January 1980 and March 2012 in PubMed and the China National Knowledge Infrastructure (CNKI). We included observational studies that focused on population groups other than commercial sex workers (CSWs) and their clients, and men who have sex with men (MSM) and quantitatively reported one of the following indicators of recent high-risk sexual behavior: premarital sex, commercial sex, multiple sex partners, condom use or sexually transmitted infections (STIs). We used generalized linear mixed model to examine the time trend in engaging in high-risk sexual behaviors.

Results: We included 174 observational studies involving 932,931 participants: 55 studies reported on floating populations, 73 on college students and 46 on other groups (i.e. out-of-school youth, rural residents, and subjects from gynecological or obstetric clinics and premarital check-up centers). From the generalized linear mixed model, no significant trends in engaging in high-risk sexual behaviors were identified in the three population groups.

Discussion: Sexual risk behaviors among certain general population groups have not increased substantially. These groups are therefore unlikely to incite a STI/HIV epidemic among the general Chinese population. Because the studied population groups are not necessarily representative of the general population, the outcomes found may not reflect those of the general population.

Figure 1. Flow chart of the literature selection process.

Figure 2. Trend analyses of indicators of high-risk sexual behavior in the floating population in China.

(a) proportion that engaged in premarital sex; (b) proportion that engaged in commercial sex; (c) proportion that engaged in sex with multiple partners; (d) proportion that used condoms with casual or commercial sex partners; (e) prevalence of STIs. The dashed lines indicate the average trends calculated by generalized linear mixed model. Detailed information about the parameters of the dashed lines is given in File S4.

Figure 3. Trend analyses of indicators of high-risk sexual behavior in college student population in China.

(a) proportion that engaged in premarital sex; (b) proportion that engaged in sex with multiple partners; (c) proportion that used condoms. The dashed lines indicate the average trends calculated by generalized linear mixed model. Detailed information about the parameters of the dashed lines is given in File S4. The grey dots (b & c) represent studies among migrant truck drivers that were not included in the average trend analysis.

Figure 4. Trend analyses of indicators of high-risk sexual behavior in young, out-of-school individuals and community residents in China.

(a) proportion that engaged in commercial sex among the community residents; (b) proportion that engaged in sex with multiple partners among community residents; (c) proportion that engaged in premarital sex among the out-of-school youth; (d) prevalence of STIs. The connected dots indicate longitudinal studies. The dashed lines indicate the average trends across the years. Detailed information about the parameters of the dashed lines was given in File S4. The grey dot (b) represents an outlier study that was not included in the average trend analysis.