A study of sexual behavior among rural residents of China

Abstract

Objective: Although the recent spread of HIV/AIDS and other sexually transmitted diseases (STDs) in China has been associated with sexual activities, little information has been available about sexual behavior in rural areas with high HIV prevalence. Studies identifying high-risk sexual behaviors are needed to formulate effective prevention programs.

Methods: A cross-sectional study design was used to measure sexual activities using a two-stage cluster sampling method. A two-part anonymous questionnaire was used. Sensitive questions related to sexual behavior were administered using a tape recorder, earphones, and an answer sheet which did not include the text.

Results: In total, 1057 subjects were interviewed. Among 886 sexually active individuals, 7.8% had >1 sexual partner, 22.8% had premarital sex, 2.4% had anal intercourse, 4.1% had oral intercourse, and 2.3% had both anal and oral intercourse. Less than 2% reported past or current sexually transmitted diseases. Overall, 10.4% used condoms; only 11.2% for every sexual act. History of premarital and extramarital sex was higher in younger people.

Conclusions: Sexual norms in rural China are changing rapidly and high-risk sexual behavior among young rural residents is increasing. Strategies to prevent HIV/AIDS should include education to promote delayed onset of sexual activity, safer sexual behavior, and condom use.

PIP: Little information has been collected about sexual practices in China's rural areas, where HIV/AIDS prevalence is increasing. A cross-sectional survey conducted in China's Anhui province in 1997 investigated the sexual histories of 1057 men and women 15-49 years of age, 878 (83%) of whom were married. Mean age at both marriage and first intercourse was 22 years for women and 23 years for men. However, mean age at first intercourse is declining over time while marriage age remains stable, providing greater opportunity for premarital sex. 22.8% of sexually active respondents--27.1% of men and 18.9% of women--acknowledged having premarital sex. For 94.9% of respondents, their first sexual partner was their spouse. 2.4% of respondents reported anal intercourse, 4.1% reported oral-genital intercourse, and 2.3% reported both practices. 1.7% of respondents had had a sexually transmitted disease and 7.8% reported more than one lifetime sexual partner. 68% of sexually active respondents reported contraceptive use, primarily condoms (10.4%). Among condom users, 11.9% used them for every sexual act, 30.5% used them only during ovulation, and 57.6% used them occasionally. Logistic regression analysis identified the following factors as significant predictors of high-risk sexual behaviors: younger age at first sexual intercourse, a desire to have multiple partners, more than two coital acts per week, exposure to pornography, higher income, and older age at marriage. These findings can be used in the design of HIV/AIDS prevention programs in rural China. Emphasis should be placed on delayed onset of sexual activity and consistent condom use.