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Original research
Potential HIV transmission risk among spouses: marriage intention and expected extramarital male-to-male sex among single men who have sex with men in Hunan, China
  1. Weizi Wu1,
  2. Xiaochen Yan1,
  3. Xiaoxia Zhang2,
  4. Lloyd Goldsamt3,
  5. Yuanyuan Chi1,
  6. Daoping Huang4,
  7. Xianhong Li1
  1. 1 Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, China
  2. 2 Nursing Faculty, Henan Medical College, Zhengzhou City, Henan Province, China
  3. 3 Rory Meyers College of Nursing, New York University, New York City, New York, USA
  4. 4 Changde Centre for Disease Control and Prevention, Changde, Hunan Province, China
  1. Correspondence to Dr Xianhong Li, Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, China; xianhong_li{at}


Objective The HIV epidemic in China is shifting from the high-risk groups of men who have sex with men (MSM), injection drug users and sex workers to the general population, and sexual contact among spouses is assumed to be one route of transmission. Our objective was to determine the intention to marry and the expected extramarital male-to-male sex among single Chinese MSM, in order to estimate the potential HIV transmission risk among MSM living with HIV and their female spouses.

Methods We conducted a web-based, cross-sectional survey between May 2016 and May 2017. A questionnaire covering sociodemographic characteristics, sexual behaviours, HIV-related and homosexuality-related stigma, marriage intention, and expected extramarital sexual behaviours was completed by 556 single MSM in Hunan, China. Descriptive statistics, χ2 test, two-sample t-test and multivariate logistic regression analysis were performed.

Results Currently 48.9% of the participants intended to marry a woman in their lifetime, and 91% of them reported that they would continue to have sex with men after getting married. Those who were living with parents (OR=2.26), self-identified as bisexual (OR=2.57), had at least one heterosexual partner in the previous 6 months (OR=0.33) and perceived a higher level of self-homosexual stigma (OR=1.78) had greater intention to marry a woman.

Conclusion Nearly half of Chinese MSM intend to marry women, which has significantly dropped from the estimated percentage more than 10 years ago for Chinese MSM. However, the expectation of extramarital homosexual behaviours was common in these men. Sexual and gender minority stresses especially from family members, homosexual identity assertiveness and related stigma were the main factors for marriage intention, which should be addressed in future studies and practices.

  • marriage
  • extramarital relations
  • sexual and gender minority
  • spouses
  • hiv infection
  • china

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  • Handling editor Jackie A Cassell

  • Contributors WW conducted the literature review and data collection, and analysed and interpreted the data in this manuscript. XY designed the questionnaire and collected the data. XZ, YC and DH assisted in data collection and revised the manuscript. XL designed and supervised the study. LG assisted in study design and manuscript writing. All authors have read and approved the final version of the manuscript.

  • Funding This study is supported by the National Social Science Fund (15CSH037), Innovation-Driven Project of Central South University (2018CX036),Project of Philosophy and Social Science Research in Hunan Province (18YBA438) and Graduate Investigation Project of Central South University (502231803).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Ethics Committee of Xiangya Nursing School of Central South University (approval no 2016026).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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