Sexually transmitted infections and risky sexual behaviors among Chinese adults

Background. Human behavior changes resulting from the substantial social and economic development in China have profound effect on the rising epidemic of sexually transmitted infections (STIs).;Data and methods. This study is a secondary analysis of data from Chinese Health and Family Life Survey. Prevalence of three STIs, Chlamydia, gonorrhea and trichomoniasis are estimated. Proximate determinants of STIs are assessed. Two important proximate determinants, concurrent sexual behavior and condom use are explored further. Two-level random intercept logistic regression and regular logistic regression are fitted to determine the effect of risk factors.;Results. The overall prevalence of STIs was 3.9% for women and 2.4% for men. Chlamydia is the most prevalent infection, with the prevalence of 2.6% in women and 2.1% in men. In women, whose primary partners socialized more frequently (OR, 1.52; 95% CI: 1.10-2.11) and who perceived primary partners have had concurrent sexual partners (OR, 2.40; CI: 1.62-3.56) have greater risk of being infected. In Men, higher risk of infection is associated with socializing more frequently (OR, 2.07; 95% CI: 1.22-3.52) having concurrent sex partners (OR, 1.87; 95% CI: 1.12-3.10) and engaging in unprotected sex with commercial sex workers (OR, 2.42; 95% CI: 1.20-4.85). Concurrent sexual behavior is more common among men than women, particularly in younger age groups. Individuals who perceived primary partners have had other concurrent sexual partners are more likely to engage in concurrent sexual behavior. More permissive community attitudes towards extramarital sex are shown as a risk factor of men's engagement in concurrent sexual behavior. The consistent condom use rate in men with primary partner is 2.4%, but 32.9% with casual partners. Better educational attainment increases men's condom use with both primary and casual partners. Living in a community where there is prevailing traditional gender norm is associated with less report of consistent condom use.;Conclusion. There is hidden epidemic of Chlamydia among Chinese general population. Men are transmitting infections to their primary partners acquired through sex with casual partners or commercial sex workers. Concurrent sexual behavior is influenced by factors operating at multiple levels. Condom use in Chinese men is partner-specific.