Sexual behavior of migrant workers in Shanghai, China

According to the published literatures, risk sexual behavior was defined as having
multiple sex partners, paying for sex, and homogeneity sex, etc. As we all know, heterosexual
transmission has become the main mode of HIV/STD transmission in China. Yang et al.
20] have found that about 40.0 % of migrants fail to understand that use of condoms decreases
the risk of HIV infection. Migrants who have engaged in sex with commercial sex workers
have better HIV knowledge than migrants who have never paid for sex. The present study
was one part of a large survey of the migrants in Shanghai. It took the participants
about 35 min to fill in the questionnaire. We only selected the condom use and casual
noncommercial extramarital sex as indices to assess the sexual behavior of migrants.
To our knowledge, this study was the first to document the sexual behavior and condom
use in China and to assess the possible factors for unprotected sex among migrant
workers.

We found a low proportion of condom use among both male and female migrant workers.
In our study, 58.0 % of participants (57.9 % and 58.1 % for males and females respectively)
never used a condom in their sexual intercourse and 76.2 % either never or only occasionally
used a condom with their casual extramarital sex. Studies in India (25.0 %), South
Africa (33.0 %) and Croatia (44.7 %) have revealed that condom use is less practiced
among migrant workers having sexual contact with any casual or commercial sexual partners
21]–23]. Wang et al. 24] have found that there are 73.7 % unmarried male migrants in Shanghai who had sexual
intercourse had not used condoms in their last sexual intercourse and 50.6 % reported
never or occasionally used a condom with their casual extramarital sex. The condom
use in general group in the present study was higher than previously reported by other
studies, but lower in the casual extramarital sex group than others. As Wang et al. 24] reported, participants who perceived themselves to be at low risk of HIV infection
were more likely to have non-regular sexual partners than those at a higher risk.,
The education of condom use in migrants is necessary especially among those who had
casual extramarital sex.

We also found the association between condom use with age, education, occupation,
monthly income, and housing. It seemed the younger migrants who earn more and had
higher education level had higher possibility of condom use. It could be explained
that the younger who were better educated had more knowledge of the HIV/STD. But several
Chinese studies thought that the primary reason given for condom use among migrants
is contraception instead of disease prevention 25], 26]. We also found that the migrants who engaged in entertainment had higher possibility
of condom use (OR: 2.03, 95 % CI: 1.62–2.54, for manufacture). In the present study, the migrants engaged
in entertainment included those who worked at bath houses, night clubs, beauty salons,
and hair salons; it could be explained by the effect of the education in high-risk
groups of HIV/STD. Condom use is one of the most effective means of preventing infection
from the sexually transmitted diseases 27]. It was reported that consistent and correct condom use could reduce the risk of
HIV infection by approximately 69 % 27], 28].

The present study also found associations between the casual extramarital sex and
gender, marital status, and industry of employment. Unmarried migrant workers had
fewer encounters with a casual extramarital partner than their married counterparts
(OR: 0.47, 95 % CI 0.38–0.57), which was different from what was observed by Wang et
al. 24]. This difference may be related to differences in the target populations of these
studies. In the present study, compared to migrant workers engaged in manufacture,
those in entertainment had fewer casual extramarital partners, which is contrary to
previously thought. This may be due to the definition for casual extramarital sex
partner in our study. It is believed that the entertainment industry is where most
commercial sexual behaviors exist. We also found that those engaged in domestic service,
which had a lower rate of condom use (27.5 %), had more possibility of having casual
extramarital sex than those engaged in manufacture. This finding is beyond our expectation.
It also suggested that we should not only focus on high risk groups but also pay attention
to low risk ones when carrying out health education of sexually transmitted diseases,
as what mentioned in the previous paragraph: those who had low risk of HIV infection
were more likely to report non-regular sexual partners than those having a higher
risk perception.

Another surprising finding of the present study was that female migrants had more
possibility of having casual extramarital sex than male ones (OR: 2.37, 95 % CI: 1.96–2.85). Fang et al. 29] studied female sex workers but did not mention their non-commercial sexual behaviors.
The further multivariate analysis indicated that those female migrants who were married,
engaging in domestic service, renting house with friends were more likely to have
casual extramarital sex (p??0.05). While for male migrants marital status was the major factor (p??0.01). Unmarried men were less likely (OR: 0.51, 95 % CI: 0.36–0.74) to have casual extramarital sex than married men, which
is inconsistent with earlier research 24], 29]. One reason may be that we surveyed the general population of migrants, and the sexual
encounters with casual extramarital partners that were considered were non-commercial
only. Another reason should be the special social-psychological characteristics of
migrants. Migration is a primary cause of behavior change. When the migrants were
away from their spouses, families and homes, they were forced into physically demanding
jobs and poor housing and living conditions, which may put them at risk of HIV infection
30], 31]. The studies in South Africa (31.4 %), North Carolina (46.0 %), and California (30.0 %)
indicated that migrant workers living apart from their wives were likely to engage
in higher rates of multiple and commercial sex 30]. Though in our study,we did not care about the commercial sex, for migrants, the
sense of emptiness and anonymity of being a foreigner might increase the risky sexual
activities. As a pity, we did not do the further research about the difference of
psychological characteristic between female and male migrants.

This study was only one part of a total study on migrant workers in Shanghai, and
has some limitations. First of all, because of the cross-sectional design and non-random,
quato sampling selection of participants, we cannot draw conclusions of the causal
relationship. Besides, the self-reported data of the migrants may cause the recall
and social desirability bias. Unfortunately, we had no laboratory test data to confirm
associations among condom usage, casual extramarital sex, and sexually transmitted
diseases 32], 33]. The study was limited to a single city, and although Shanghai has one of the largest
migrant populations in China, it is hard to draw a general conclusion on the sexual
behavior of migrant workers in all of China. And because of limits of the time and
fund, we also did not include other sexual behaviors such as homosexual intercourse
and engaging multiple sexual partners.