Study On Unprotected Sexual Behavior And Its Factors Among People Who Have Nonmarital And Noncommercial Heterosexual Contact

Backgrounds:The most important factor of the HIV epidemic in China is heterosexual contact of which non-marital and non-commercial heterosexual contact(NMCHC)has become as one of crucial transmission models.However,most of studies related with NMCHC and HIV risk focused on characteristics of people living with HIV(PLHIV),none of researches has explored unprotected sexual behaviors and characteristics,and related influences among people with NMCHC in China.Objectives:The study aimed to learn multi-dimensional characteristics of people with unprotected NMCHC,demonstrate HIV-related characteristics in different dimension and detailed representations in each dimension,analyze the key influences on HIV-risk sexual behaviors of people with NMCHC,and identify subgroups which are more likely to engage in HIV-risk sexual behaviors.All of study objectives were intended to support to strengthen awareness of and capacity to prevent against HIV among common people for decision makers from both systematic and taxonomy-guidance views.Methods:The first-stage study,data analysis based on case report information between 2015 and 2017,aimed to analyze characteristics of PLHIV who reported their transmission were NMCHC,and explored which subgroups were of more odds to be diagnosed through the channel of Voluntary HIV Counseling and Testing(VCT);The second-stage study,qualitative research,was designed to build socio-ecological framework of HIV risky behaviors among people with NMCHC based the materials of in-depth interviews of which interview outline were constructed from socio-ecological perspectives;The third-stage study,quantitative survey,was planned to evaluate the impacts of these multi-dimensional characteristics on HIV risk sexual behaviors by using Logistic regression,latent class analysis(LCA),and structure equation model.Questionnaire design was referred to results of qualitative study,and participants were those who experienced NMCHC and sought for VCT.Results:Among PLHIV who suffered HIV through NMCHC,those who aged 15 to 59 accounted for 77.2%(1617/2096),the male accounted for 58.8%(1232/2096),those who received the education of primary school or less accounted for 42.0%(880/2096),those who married or ever married accounted for 78.8%(1651/2096),those who experienced migrant working accounted for 29.1%(610/2096),and more than three nonmarital sexual partners accounted for 15.9%(334/2096).After multifactor logistical regression analysis,female(OR:10.35,95%CI:8.25-12.98),younger age,education above college level(OR:1.61,95%CI:1.06-2.46),working about catering and infrastructures(OR:1.51,95%CI:1.18-1.95)were more associated with reporting infecting through NMCHC transmission compared to commercial transmission.LCA model identified four subgroups:the educated non-farm youth(39.2%),the young male farmers(20.9%),the young female farmers experienced marriage(20.7%),and the old farmers(19.2%).the old farmers among participants in the educated non-farm youth(OR:2.34,95%CI:1.71-3.19)were nearly twice times more likely to be diagnosed through the service of VCT compared to the old farmers.Total of 67 one-by-one in-depth interviews were completed in two-round process between March and June in 2018.Among participants who received interviews,Male equal to female,those who have experienced marriage occupied 89.5%,age mainly ranged from 15 to 60(95.5%),rural-to-urban migrants accounted for 68.7%,those who have two or two more NMCHC partners accounted for 74.6%,and at least one time of condom use in NMCHC accounted for 46.3%.After qualitative analysis of interview materials,Personal HIV risk awareness through NMCHC,and migrant experience are the factors of unprotected sexual behaviors among NMCHC population,and getting along with NMCHC partners,peers and familial parents and relations,and Internet and social media and other macro social environment are the factors associated with HIV risk awareness through NMCHC and their unprotected sexual behaviors.Moreover,typical case analysis was used to depict social environment of specific interviewees,including those had experienced "left-behind children","empty-nested elders","left-behind married women","having sex with net-met partners","female sexual workers",or "forced sex" as well as those young university students and those civil servants who have married or divorced.Total of 1085 participants completed questionnaires,average age with 35.4,73.6%(798/1085)was male,those who received less than six-year education occupied 10.5%(114/1085),37.8%(410/1085)was unmarried,those who ever experienced migration accounted for 81.6%(886/1085),those who reported had at least one type of HIV risk sexual behaviors(never condom use,anal sex,concurrent multi-partner sexual behaviors,and perceived bleeding during NMCHC)accounted for 37.6%(408/1085)for nearly a year,and diagnosed cases accounted for 4.9%(53/1085).There were statistical significances between male and female in distribution of measure variables of latent variables parental influences,peer influences,Internet dating and sexual partners'influences.Awareness of condom use during NMCHC,sexual health communication between parent and children at teenagers,party frequency and sexual health communication among peers,internet dating,and communication about condom use during dating with opposite partners were associated with unprotected sexual behaviors for nearly a year.LCA identified five subgroups:The first subgroup was those who have close social relationships with nearby population;The second subgroup was those who engaged in seeking partners through Internet;The third subgroup was those who have weak social relationships with nearby population;the forth subgroup was those who engage in social interactions with weak sexual health support;The fifth subgroup was those who had unclear perception of their nearby population they contacted.The second subgroup,represented those engaged in seeking for partners through Internet,has more probability to experience HIV risk sexual behaviors than another four subgroups.The results of SEM model found that the latent variable of the influence of online dating through the variable of HIV risk awareness was associated with increased HIV risk behaviors among people with NMCHC.Conclusions:Diverse representations of unprotected sexual behaviors,weak awareness of HIV expose through NMCHC,lack access to information and service of sexual health in social lives,and increasing Internet dating are likely to increase the risk of HIV exposure when people engages in NMCHC.We emphasized that online dating played a crucial role in the HIV epidemic among people with NMCHC.