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Try out PMC Labs and tell us what you think. Learn More. This study assessed key characteristics of this subgroup of men who have sex with men MSM in China. Of eligible MSM, Besides marriage as a strong predictor odds ratio: H omosexuality has a long history in China, and can be traced with historical evidence back to the Shang dynasty in — BC. In the past decade, men who have sex with men MSM have become visible; 3 however, homosexual behaviors still carry a stigma in Chinese society and the stigma for MSM is mainly due to social norms against homosexuality, males' responsibility to carry the family line, and their high risks for human immunodeficiency virus HIV infections or sexually transmitted infections STIs.

Because HIV prevalence has increased from 0. Numerous publications have assessed the prevalence of having female sexual partners among Chinese MSM, 9 — 13 but there is no study investigating the predictors for bisexual behaviors and comparing the sexual behaviors among those who ever have and those who never have female sexual partners. We conducted this study in the metropolitan city of Beijing, China to evaluate the demographic factors related to the behavior of having had sex with women among Chinese MSM.

We conducted a cross-sectional study among MSM in Beijing during and Participants were recruited from the community by using mixed sampling approaches, including VCT clinic patients, advertisement on gay websites, outreach to MSM frequented venues e. The inclusion criteria were: 1 self-reporting anal sex with men in the past 3 months; 2 age 18 years or older; 3 living in Beijing more than 12 months; 4 able and willing to provide consent.

Trained investigators administrated a questionnaire-based interview with each participant to collect data on demographic characteristics, sexual behaviors, drug and alcohol use, and history of STIs. A blood sample was collected from each participant and tested for HIV and syphilis infections. Ltd, Beijing, China. We report only confirmed HIV and syphilis infections. Of interviewed MSM, were included in this analysis; 14 participants were excluded due to missing data regarding the outcome variable of ever having had sex with women. The outcome variable was defined as a dichotomous variable, and potential demographic predictors were explored.

Confounders for each covariate were identified based on directed acyclic graph DAG analysis and biological plausibility. We compared demographic covariates between men who have sex with men only MSMO and MSMW in univariate logistic analyses, and the association between outcome variable, and each demographic predictor was adjusted for specific panels of confounders using multivariable logistic regression models. As marriage could be a strong predictor for bisexual behaviors among MSM in China where gay marriage is not legalized, we also performed subgroup analysis among unmarried MSM.

All analyses were conducted using SAS Software version 9. Of participants, the median age was 28 years interquartile range [IQR] 24, 34 ; the majority were of Han ethnicity Nearly half Being ever married was a strong predicator for having female sexual partners adjusted odds ratio [aOR]: There was no association between occupation and having had female sexual partners after the adjustment for age, race, education, and Beijing Hukou or household registration. CI, confidence interval; IQR, interquartile range; NA, not applicable no confounding variables according to the directed acyclic graph analysis ; OR, odds ratio.

About three-quarters Five percent of participants had a history of commercial sex; over a quarter There were no statistical differences between two groups on travelling to other cities, history of drug use, and history of STIs.

Our study found that over a quarter If a man gets older but has not married, colleagues and friends might also be curious why he is not married and even consider him as abnormal. Due to these social and family pressures, many MSM eventually choose to marry a woman and have a baby; they use the marriage as a sort of disguise, fulfilling their perceived social obligation and avoiding stigma.

Fewer MSM are married to women in Western countries, ranging from an estimated 1. Lower marriage-to-women rates, then, may reflect greater MSM self-efficacy and choice, including whether to marry a woman or have children. One ificant social consequence of marrying a woman by a homosexual man is an unhappy marriage for both partners. An estimated 16 million Chinese MSM are married. We found older MSM were more likely to have ever had sex with women and a possible explanation is that as Chinese men were getting older, they might face more pressure from society and family to marry and have female sexual partners than younger men.

Another possible reason is part of generational pressure that affects older people more than younger people, as being MSM is becoming less stigmatized over time. We also found that less educated MSM were more likely to have female sexual partners, and a possible reason is that they tended to be subjected to influence of traditional social norms. We are interested in any difference in HIV-related behaviors and disease rates among MSM who have and do not have female sexual partners. Our study showed difference in several behaviors, such as alcohol drinking and sexual role preference, but no difference in prevalence of HIV and syphilis infections.

Our study has limitations. Our study participants were recruited using mixed approaches; therefore they were a convenience sample. The primary outcome of having female sexual partners was based on self-reporting; therefore we could not exclude the possibility of information bias. However, our finding on bisexual behaviors among Chinese MSM is consistent with the literature. In conclusion, our study primarily characterized MSMW features, and provided valuable information for future intervention.

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Author information Copyright and information Disclaimer. Corresponding author. Address correspondence to: Dr. E-mail: ude. Copyright , Mary Ann Liebert, Inc. This article has been cited by other articles in PMC. Introduction H omosexuality has a long history in China, and can be traced with historical evidence back to the Shang dynasty in — BC. Questionnaire interview and laboratory testing Trained investigators administrated a questionnaire-based interview with each participant to collect data on demographic characteristics, sexual behaviors, drug and alcohol use, and history of STIs.

Statistical analysis Of interviewed MSM, were included in this analysis; 14 participants were excluded due to missing data regarding the outcome variable of ever having had sex with women. Demographics Of participants, the median age was 28 years interquartile range [IQR] 24, 34 ; the majority were of Han ethnicity Predictors for having female sexual partners Univariate analyses indicated MSMW were more likely to be older or married, and less likely to have college education or be stably employed than MSMO Table 1.

Table 1. Open in a separate window. Table 2. Discussion Our study found that over a quarter Author Disclosure Statement No competing financial interests exist. References 1. Ruan FF. Tsai YM. Male homosexuality in traditional Chinese literature. J Homosex. Liu H. Yang H. Li X, et al.

Sex Transm Dis. Qian HZ. Vermund SH. Wang N. Sex Transm Infect. Neilands TB. Steward WT. Choi KH. Assessment of stigma towards homosexuality in China: A study of men who have sex with men. Arch Sex Behav. Choi K-H. Diehl E. Yaqi G. Mandel J. High HIV risk but inadequate prevention services for men in China who have sex with men: An ethnographic study. AIDS Behav. Wang L. Norris JL. Li DM. Guo W. Ding ZW. HIV prevalence and influencing factors analysis of sentinel surveillance among men who have sex with men in China, — Chin Med J Engl ; — Wang Y.

Lin P, et al. Ding ZW, et al. Feng T. Liu H, et al. Egocentric networks of Chinese men who have sex with men: Network components, condom use norms, and safer sex. Liao M.

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