recent research indicates that a significant portion of men who have sex with men (msm) in china engage in group sex. this practice, often intertwined with other high-risk sexual behaviors, presents a complex challenge for public health initiatives aimed at preventing the transmission of sexually transmitted infections like hiv and syphilis.
prevalence and characteristics of group sex engagement
our findings suggest that approximately one in ten msm in china participate in group sex.
while this figure is slightly lower than that reported in some western nations, it is comparable to rates observed in other low- and middle-income countries. the data also reveal a notable association between group sex and engagement in other risky sexual activities. for instance, a substantial percentage of survey respondents who engaged in anal intercourse also reported participating in group sex.
specifically, around three-quarters of those surveyed indicated involvement in group sex, with nearly two-thirds reporting condomless anal intercourse. further analysis indicates that hiv testers were more likely to have engaged in group sex within the preceding twelve months compared to msm who had never undergone hiv testing.
after accounting for variables such as age, place of residence, educational attainment, marital status, and income level, our study found a clear link between group sex and engaging in condomless anal intercourse with male partners in the last three months.
additionally, participation in group sex was positively correlated with having a positive hiv test result. these findings underscore the complex interplay between group sex and several high-risk behaviors, creating an environment that can facilitate disease transmission.
the role of gay applications in facilitating group sex
the proliferation of gay dating and networking applications has emerged as a significant factor influencing sexual practices among msm in china.
our research indicates that overall, users of these applications are more prone to engaging in group sex compared to non-users. this association remains significant even after adjusting for various demographic and behavioral factors.
delving deeper into the specifics of gay app usage, we identified certain features that are particularly correlated with a higher frequency of group sex.
the number of sex partners met through a gay app within a six-month period showed a positive correlation with group sex participation. similarly, the number of receptive anal sex acts with partners met through these apps, as well as the number of insertive anal sex acts, were also associated with an increased likelihood of engaging in group sex.
these insights suggest that gay applications may be creating a virtual risk environment, effectively facilitating the organization and execution of group sex encounters.
the geospatial technology embedded within many gay apps allows for the rapid identification of potential partners and networking, unhindered by traditional constraints of time and location.
this can lead to expedited sexual encounters, potentially increasing the frequency of both casual and group sex. the ease with which connections can be made and rendezvous arranged through these platforms appears to be a key driver in this trend.
intersection with commercial sex and other high-risk behaviors
our study also highlighted an intersection between group sex and commercial sex activities.
a notable proportion of msm who reported exchanging sex for gifts or money also engaged in group sex. this finding aligns with research conducted in other regions, suggesting that group sex may be a common practice among male sex workers and that there is a discernible overlap between these two behaviors.
further analysis of high-risk sexual behaviors associated with group sex revealed consistent patterns with studies conducted in australia, the united states, and the united kingdom.
for instance, men who participated in group sex within the preceding six months were found to be more likely to engage in unprotected anal intercourse. another study in the united states demonstrated a significant association between the number of unprotected receptive anal sex acts at sex parties within the past year and an increased likelihood of engaging in unprotected anal sex with serodiscordant partners at those same parties.
hiv status and group sex engagement
a significant finding of our research is that msm living with hiv were more likely to engage in group sex compared to their hiv-negative counterparts.
this observation is consistent with patterns observed in australia and the united states. while our study did not collect specific data on serosorting practices, the results strongly indicate a high prevalence of condomless group sex among msm living with hiv. this is a concerning public health issue with substantial implications for hiv transmission dynamics within this population.
contextualizing group sex in china: societal factors and limitations
the frequency of group sex observed among msm in china is lower than reported in some western countries.
this disparity may be partly attributable to differences in societal acceptance of non-mainstream sexual identities and practices. china is undergoing a significant sexual revolution, with evolving sexual behaviors and practices. however, in recent years, the space for advocacy by lesbian, gay, bisexual, and transgender (lgbt) organizations has contracted.
crackdowns on civil rights movements and online dissent have also impacted the visibility and activities of lgbt groups.
several events have underscored the challenges faced by the lgbt community and its allies in china. the closure of lgbt organizations due to external pressures, the departure of activists from the country, and the mental health toll on those striving for social change highlight the difficult environment.
these challenges can affect the open discussion and research into sexual health behaviors.
it is important to acknowledge the limitations of this study. as an online survey, there is an inherent risk of selection bias, as individuals without internet access were excluded.
the msm population in our study was also younger and more highly educated than the general population of gay men in china. furthermore, all reported behaviors were self-reported, which can be influenced by social desirability bias. a notable number of individuals who initiated the survey did not complete it, potentially leading to further selection bias.
consequently, the findings should be interpreted with caution. additionally, the study did not gather detailed information on the specific mechanics of group sex or the types of condom use employed during these encounters.
public health implications and future directions
the association between group sex and other high-risk behaviors suggests that group sex may be a component of a broader syndemic—a clustering of health-related problems that interact synergistically to exacerbate an existing health problem, such as hiv transmission among msm.
this complex interplay necessitates comprehensive interventions that address multiple risk factors simultaneously.
future research should aim to explore the specifics of group sex behavior in greater detail, including the types of condom practices and other associated high-risk activities such as drug use.
anthropological studies could also provide valuable qualitative insights into the motivations and drivers behind group sex participation, shedding light on the social and psychological dimensions of these behaviors.
from a public health and medical standpoint, gaining a more profound understanding of group sex is highly relevant.
interventions designed to mitigate the spread of hiv and syphilis among msm should consider the role of group sex as a potential risk factor and target these behaviors effectively. by understanding the multifaceted nature of these practices, public health strategies can be better tailored to protect the health of this vulnerable population.
we acknowledge the invaluable support of dr.
ying-ru lo, dr. pengfei zhao, dr. peter vickerman, dr. kate mitchell, ben cheng, dr. kate muessig, thomas cai, dee poon, gang meng, lloyd chao, richard youngblood, and kit hung. our gratitude also extends to all the study participants and the dedicated staff members at sesh global, danlan, jiangsu tongzhi, yunnan tongzhi, and the guangdong provincial centers for skin diseases and sti control for their contributions.
author contributions: conceptualization: wt, st.
data curation: yz, cl. formal analysis: wt, st. funding acquisition: cw, jt, wt. investigation: wz, cl. methodology: wt, st, jt, cw. project administration: yz. resources: cw, by, jt. software: wt. supervision: wt, jt. validation: st, jt. visualization: wt. writing—original draft: wt, st.
study methodology: an online survey was conducted between september and october to collect data on socio-demographics, sexual behaviors, gay app usage, and the occurrence of group sex among chinese msm.
the survey instrument was developed through initial interviews with 20 msm and key stakeholders to ensure the appropriateness of online survey questions.
measures included: socio-demographic information such as year of birth, occupation, marital status, education level, annual income, and residence type (urban or rural).
data on sexual behaviors, including participation in group sex and condom use, were also collected. information regarding gay app usage, including features and frequency of use, was a key component of the survey.
ethical considerations: this study received approval from the ethics review committees at the guangdong provincial center for skin diseases and sti control in china, and the university of north carolina at chapel hill and the university of california, san francisco in the united states.
results overview: out of 5, clicks on the survey link, 1, individuals withdrew before signing the consent form.
from the 1, participants who signed the consent form, the majority were under 30 years old. table 1 detailed the factors associated with group sex, with 9.8% of the overall sample reporting participation. table 2 highlighted the correlation between gay app use features and group sex, indicating that gay app users were more likely to engage in group sex with an adjusted odds ratio (or) of 1.87.
table 3 further elaborated on these correlations.
discussion on group sex and hiv transmission
group sex frequently co-occurs with other high-risk behaviors, collectively creating an environment conducive to disease transmission. our study expands upon existing literature by utilizing online msm portals, gathering detailed information on gay app usage, and investigating the specific correlation between group sex and such application use.
the findings underscore that gay app usage may contribute to a virtual risk environment that facilitates group sex. this complex phenomenon, often referred to as a syndemic, can exacerbate the spread of hiv and syphilis among msm, necessitating comprehensive public health interventions that address the multiple interacting risk factors.
acknowledgments: we express our sincere thanks for the support provided by dr.
ying-ru lo, dr. pengfei zhao, dr. peter vickerman, dr. kate mitchell, ben cheng, dr. kate muessig, thomas cai, dee poon, gang meng, lloyd chao, richard youngblood, and kit hung. we are also grateful to all the study participants and the staff members at sesh global, danlan, jiangsu tongzhi, yunnan tongzhi, and the guangdong provincial centers for skin diseases and sti control.
references:
- xiao z, mehrotra p, zimmerman r.
sexual revolution in china: implications for chinese women and society. aids care.
- bien ch, best jm, muessig ke, wei c, han l, tucker jd. gay apps for seeking sex partners in china: implications for msm sexual health. aids and behavior.
- watt lp a.
the broader societal context in china reveals a complex landscape for lgbt individuals and organizations.
while homosexuality was decriminalized in 1997 and no longer classified as a mental disorder in 2001, the space for lgbt advocacy has diminished in recent years. government notices suggesting young men had become too "feminine," alongside regulations banning "effeminate" aesthetics in entertainment and promoting more masculine imagery, reflect a tightening of social controls.
these developments occur even as some lgbt individuals, like ma baoli, founder of the gay dating app blued, have achieved public prominence. however, even successful ventures have faced challenges, with ma baoli's resignation hinting at the difficulties of operating an lgbt business within the current chinese environment.
the app, bluecity, became the world's first publicly traded LGBT social network, but the future of such ventures remains subject to the evolving regulatory and social climate.