Risky Sexual Behaviors of Male Bachelors in the Context of the Male. marriage-squeeze : An exploratory survey in urban Xi an, China.

Transcription

1 Risky Sexual Behaviors of Male Bachelors in the Context of the Male marriage-squeeze : An exploratory survey in urban Xi an, China Bo Yang 1, Isabelle Aattane 2, Shuzhuo Li 1, Xueyan Yang 1 Session "151" Sexual and reproductive health services to meet men s needs at 8:30am-10:00am Room 201, Convention Hall, 2nd Floor. 1 Institute for Population and Development Research, School of Public Policy and Administration, Xi an Jiaotong University, China. 2 National Institute for Demographic Studies (INED, Paris) 1

2 Risky Sexual Behaviors of Male Bachelors in the Context of the Male marriage-squeeze : An exploratory survey in urban Xi an, China Bo Yang 2, Isabelle Aattane 2, Shuzhuo Li 1, Xueyan Yang 1 1 Introduction In the last 30 years, China s gender imbalance has being increasing. In 2010, China s overall sex ratio, namely the ratio of males to females, was the highest in the world after that of India, males for 100 females, while the world average (excluding China and India) stood at 98.5 (United nations, World Population Prospects, 2010). Among young children (0 to 4 years-old), the sex ratio reached boys per 100 girls in 2010 (The Sixth National Population Census of China), which is almost 20 percent above the expected levels. The projected male surplus among young Chinese adults in the coming decades, is raising various questions. While previous research has investigated the impact of the male surplus in the marriage and sexuality markets on the prevalence of same-sex sexual behaviors among rural migrants in urban areas (Yang et al. 2012), the present article addresses the consequences of the gender imbalance for the propensity of the marriage-squeezed male migrants to participated in sexual behavior with casual partners, in particular commercial sex, that could threaten their health by increasing their exposure to STIs. This study is based on data from the Survey on Reproductive Health and Family Life of Migrant Male Bachelors in Urban Areas conducted in Xi an City, Shaanxi Province, in December 2009 and January Context and research questions The male marriage-squeeze, migration and sexuality Gender imbalance at birth, with more boys born than girls, is currently the major cause of the demographic gender bias in China (Li Shuzhuo et al, 2006). There is a strong preference for sons rooted in the Confucian culture and exacerbated by the fertility decline, 2 Institute for Population and Development Research, School of Public Policy and Administration, Xi an Jiaotong University, China. 2 National Institute for Demographic Studies (INED, Paris) 2

3 especially in rural areas (Poston et al, 2005; Li Shuzhuo et al, 2006). However, the surplus of males in China is also a result of the higher female mortality rate that has characterised the greater part of the 20 th century (Klasen et al, 2002). This surplus of males is creating a hitherto unparalleled situation in the documented history of human populations, both in its scale and its lasting impact on population structure and numbers. In particular, the gender imbalance recorded today, especially as regards children, will have progressive repercussions on the adult population as they age (Attané 2013). For example, the number of men per 100 women amongst year olds will exceed 117 in 2050, that is to say 13 points more than in Although the Chinese government has implemented series of public policies to address the negative outcomes of gender imbalance (Li Shuzhuo et al, 2012), the surplus of men among adults of marriageable age is expected to reach 30 million in 2020 (Jiang et al, 2010). This shortage of women on the marriage market will also be exacerbated by the numerical gap between successive cohorts: when the number of births drops dramatically over the years, as it has done in China since the 1970s, the number of boys in marriage market, is greater than the number of girls whom they are supposed to marry. This problem is also exacerbated by the age-gap between spouses. For example, the number of men arriving on the marriage market will be far greater than the number of women several years their junior. Moreover, it is precisely when they reach adulthood that the surplus of men will have its most obvious consequences both from an individual and a collective point of view. In a situation where there will be fewer adult women than adult men for the foreseeable future, various questions arise. The most immediate consequence of this male surplus will be a shortage of potential female partners on the marriage and sexuality markets since there will be significantly more men than women among young adults and the marriageable-age populations. Yet in China, marriage is almost universal and the idea that everybody should get married is still widely prevalent (Yang L, 2007). However, the male surplus combined with the social practice of marrying up, in which women usually marry men with better socioeconomic conditions, men with low socioeconomic status can hardly find women to marry (Guo, Z. G et al, 2000). Therefore, an 3

4 increasing number of men in poor socioeconomic conditions, who are mostly from rural areas, will have to postpone their marriage or to remain permanently single (Guo, Z. G et al, 2000). Previous research indicates that the characteristics of marriage-squeezed men, also called the forced male bachelors, are as follows: they are older than 28 years, mostly located in remote rural areas, with low levels of education and income, and lacking social capital (Wei et al, 2008; Li Yan et al, 2009; Wei et al, 2011). Sexual health and condom use among male migrants In Chinese culture, marriage generally remains a prerequisite for family formation and, in rural society particularly, the legitimate setting for sexual activity. For instance, sexual education to teenagers in schools and to couples as presented by the reproductive health services, still considers hetero-sexual marriage as the only precondition for sexual activity (Chilla, 2005; Sun,et al., 2009). Under such circumstances, forced bachelorhood coupled with the impossibility to form a family and have legitimate sex within heterosexual marriage is apt to produce privations on various fronts. Therefore, it must be considered that marriage-squeezed men may look for alternatives to partnered-sex within marriage (Zhang et al., 2009), as the rigid connection between sexual activity and marriage is only slowly being relaxed in today s China (Pan et al, 2004). At the same time, while China is experiencing economic, social, and demographic transitions, there are increasing flows of rural urban migrations which reached 221 million people in 2010 (State Bureau of Statistics of China, 2011) that affect both rural and urban societies. In this context, most rural marriage-squeezed male bachelors are migrating to cities under the double pressure of marriage and economic needs (Yang et al., 2012). It is noteworthy however that the number of sexual partners among rural male bachelors increases when they migrate into cities. For instance, it was shown that unmarried rural migrants more frequently experience commercial and casual sex with multiple partners than those who do not migrate (Kobori, 2007; Pan et al, 2004). Non-marital sex among Chinese male migrants, especially among the unmarried, has proven 4

5 to be related to HIV/AIDS and transmission of STIs due to a low rate of condom use (Li Xiaoming et al, 2004; Hong et al, 2006). Migrant males with little education, in particular, usually have a little knowledge about sexual health, which produces among them a high prevalence of unprotected sex (Yan Hong et al, 2006). A survey on Chinese migrants indicates that most of migrants commercial sex experiences occur in small shops (such as barbershop ), where the price of commercial sex and the rate of condom use are low (Pan et al, 2004). This study also reveals that these migrants face high sexual risk during their migration experience in urban areas. Some researchers found that the cost of a condom and the level of knowledge about sexual health are key-determinants in the decision to purchase and then use a condom, in particular for male migrants who have low income and education levels (Yang et al, 2011). However, unmarried males with migration experience may be more active in searching for alternatives to partnered-sex within marriage as their income and social resources are greater than non-migrants bachelors (Li X.M. et al, 2004). Existing research discusses sexual risks and reproductive health in the context of gender imbalance in China (Merli et al, 2006; South et al, 2010). Considering the low prevalence of partnered-sex intercourse among the forced male bachelors in rural areas (Li et al. 2010), it is also relevant to discuss their general situation and the impact of bachelorhood on their sexual activity and health when they migrate to cities. This paper analyses the sexual activity of unmarried males during their migration experience and compares their behaviors to those of the married male migrants from three aspects, in the context of gender imbalance: (1) What are the characteristics of the unmarried male migrants sexual behaviors? (2) Do the unmarried male migrants face high health risks during their sexual intercourse?if yes, are these risks age-dependent? (3) What are the respective circumstances of the unmarried male migrants and of the other migrants during potentially risky sexual behaviors, and what are the factors underlying such risks? 2 Literature review 5

6 Living characteristics and sexuality of forced male bachelors The high premium still placed on marriage and parenthood is known to result in family and social pressure on unmarried people once reached a certain age, especially in rural areas (Li Yang, 2007). Another reason for the social pressure on them is that they usually have poor social resources and relationships, and therefore feel lonely and helpless (Wei et al, 2008). Actually, in the social and cultural context of rural China, people who have access to marriage within which they can have legitimate sex and cohabit with a partner and eventually have children, and those who don t, i.e. the bachelors, whose sexual activity and possibility to form a family are deficiently not socially acceptable, form two distinct groups with specific behaviours and characteristics (Attané et al. 2013). A characteristic of the forced male bachelors, for instance, is that they have no partner to take care of them, which results for some of them in poor health (Li Yan et al, 2009). As mentioned above, forced male bachelors in rural areas, where the traditional culture is still prevalent and where social norms still strongly influence behaviors, have infrequent sexual experiences (Li Shuzhuo et al, 2010) and, since their economic resources are insufficient, it is difficult for them to establish relationships with women (Wei et al, 2011). In addition, sex workers in villages are not as numerous as in the cities, and this significantly reduces the alternatives for the forced male bachelors to partnered-sex within marriage (Zhang et al., 2009). On the other hand, most forced male bachelors are cohabitating with family members; they therefore enjoy only little privacy in their daily life, and this obviously affects their sexual activity (Attané et al, 2013). Generally speaking, forced male bachelors experience significant social pressure, and have to face gossip because they are childless, since China s traditional culture emphasizes the perpetuation of family line (Li Yang, 2007). In many respects, forced male bachelors are not on an equal footing with married men, and their situation is even worsened by the gender imbalance in the marriage and sexuality markets, to which they have only a limited access. Migration and sexual behaviors Existing research on migrants finds that male migrants have a higher frequency of sexual 6

7 intercourse than female migrants; furthermore, unmarried male migrants have more casual partners, since the traditional culture doesn t permit sex outside marriage (Crosby et al, 2003; Hutchinson et al, 2007). Among male migrants, those who are married but migrate without their spouse will expand their social network and can have easier access to casual partners such as commercial sex workers (Fritz et al, 2002; Crosby et al, 2003). During the migration experience, their increase in income makes it easier for them to have sex without being married (Crosby et al, 2003; Kobori et al, 2007). Younger male migrants have a higher frequency of sexual intercourse and more ways to have access to sexual partners than older ones (Fritz et al, 2002). As observed elsewhere, unmarried male migrants in China, as well as the married who migrate without their spouse, have an increased frequency of non-marital sexual intercourse compared to those who do not migrate. For instance, there is a significant prevalence of sexual intercourse with casual partners and commercial sex workers among migrants in East-coast cities (Li Xiaoming et al, 2007). As the country is experiencing great social and economic transformations, rural migrants are increasingly influenced by urban norms, where sexual activity is not necessarily associated with reproduction, and is also a way for experiencing individual pleasure (Huang et al., 2011). The improvement of individual socioeconomic conditions allowed by migration is also a factor contributing to an increase in the frequency of sexual intercourse with casual sex partners including commercial sex workers (Parish et al, 2007). For instance, male migrants with a higher educational level, and therefore higher income, are more likely to have sexual relationships with casual partners (He N. et al, 2006). However, migrant males in China usually has similar education and income, they are more likely to be the same social group with low socioeconomic conditions. Therefore, the influence of education and income on risky sex behaviors among enforced male bachelor may be different from that in former researches. Sexual risks and condom use among male migrants Condom use during a sexual intercourse can prevent sexual infections, such as HIV/AIDS or other STIs (World Bank, 1997). In countries with a high prevalence of HIV/AIDS, as in 7

8 Africa, unprotected sex with multiple casual partners is a major cause of the prevalence of STIs (Fritz et al, 2002). Commercial sex without condom use is also related to high risks of sexual infections (Crosby et al, 2003; Thurman et al, 2006; Hutchinson et al, 2007). Thus male migrants, who usually do not use condoms (Bilsborrow et al, 1984), face greater risks due to their higher frequency of sexual intercourse with casual partners and commercial sex workers. It is also noteworthy that the prevalence of condom use among the youngest unmarried migrants is even lower than among married migrants (Li Xiaoming et al, 2007; Zong Zhanhong et al, 2008;Semple et al, 2004). Therefore, unmarried male migrants face greater risks to their sexual health in cities (Hong et al, 2006; Kobori et al, 2007). Condom use among male migrants is influenced by various factors, such as attitudes toward condom use. For instance, migrant males who have a negative attitudes toward condom use usually consider it as a contraceptive device but not as a means of protection (Cohen et al, 2009); therefore they have greater risks to be infected by HIV/AIDS or STIs, as they usually refuse to use condom during sexual intercourse (Orubuloye et al, 1991; Le et al, 2006; Cohen, 2009). Male migrants, in particular the eldest ones, can also be influenced by subjective norms. Younger migrants may be easier influenced by such subjective behavioral norms. Another important factor influencing behaviors is the use of pornographic materials, such as films or journals, by which male migrants get misleading information about sexual health and that does not encourage condom use (Ghule et al, 2007). Considering the positive correlation that exists between the knowledge about reproductive health and the propensity to use condom (Zong Zhanhong et al, 2008), unmarried male migrants in China may be more likely to have unprotected sex due to their low level of knowledge about reproductive health. At the individual level, education has inconsistent influences on behaviors. For instance, male migrants with high educational level in developed countries have less frequent unprotected sexual intercourse than those with low education, whereas the relationship is reversed in developing countries (Li X.M. et al, 2007; Jung et al, 2009). Similarly, income level has 8

9 inconsistent influences on men depending on their marital status. For instance, for married men, the higher the income, the lower the frequency of unprotected sex, whereas for unmarried men, the higher the income, the higher the frequency of unprotected sexual intercourse (Shrier et al, 2001). Considering the conclusions from the literature review above, male bachelors who migrate to cities in China are facing an increased propensity to participate to unprotected sex and therefore greater risks for sexual health. It is thus relevant to focus on male bachelors in cities in the specific context of gender imbalance, and therefore to provide various recommendations to address the issue of sexual health. 4 Methods Data collection According to the Regulations on Family Planning among Migrants, the migrant population refers to adult people who left their originally registered place of residence for another place in order to work.. The data used in this study are from the Survey on reproductive health and family life of migrant male bachelors conducted in Xi an city in December 2009 and January The registered population in Xi an was 8.5 million at that time, and the migrant population exceeded 2 million, making it the most populous in the province. In addition, the number of migrants in Xi an is increasing by 10% annually 3. Considering that migrants are dispersed through the city and consequently hard to locate, it was not possible to use random sampling or door-to-door interviewing methods. Therefore, three informal labor markets and two construction sites where male migrants are concentrated were selected as locations for the survey. In the absence of any sampling basis (as no official information or statistics are available on migrants in the informal labor market), random sampling cannot be used. Considering the specific context, the only applicable sampling method was convenience sampling, which consists in directly getting in touch with individual migrants met in these informal labor markets, if they agree to participate in the survey. We used a similar method to reach migrants working on construction sites and other places where 3 9

10 the male migrants are concentrated as construction workers. Because of the sensitivity of our research questions, we did not get support from the companies, which refused to give us name lists of their workers. Therefore, several workers were directly contacted on the construction sites and asked if they would agree to participate in the survey and introduce other workers to us. To guarantee anonymity of the respondents and allow them to feel free in their responses, the CAPI (computer assisted personal interviewing) method was used. We designed a program for interviewers on the spot to input an identification number as the unique certified identity to avoid double counting. This identification number also includes individual birthday information so that we can estimate the participants age and exclude those aged less than 28 years and above 65. All the interviews were arranged in a closed and quiet environment. Before starting the process, an interviewer read to each respondent the regulations concerning privacy protection and informed them of the possibility of withdrawing at any time. Then interviewers explained to participants how to manipulate the computer in order that they could fill out the questionnaire on their own. During the process, however, an interviewer was present to give technical assistance when necessary, but sat in front of the respondent so that he could not see the computer screen. In total, 979 men participated in the survey, of whom 26 withdrew for various reasons including excessive length of the questionnaire or sensitivity of the issues. However, we achieved a high response rate of 97%. Another 14 questionnaires were removed from the database because the persons interviewed could not be considered as migrants. This resulted in 939 usable questionnaires that were considered for the final data analysis, including married male migrants and male migrants unmarried but living with a partner, who were used as reference populations. In the survey, twenty-eight years of age was considered as a threshold age for male marriage, after which chances of marrying are significantly reduced (Wei et al, 2008), and sixty-five years of age has been considered as an upper limit, due to the significant decrease both in migration experience and sexual activity beyond this age. However, as recent research considers the age of 30 as a more relevant threshold age for male marriage (Attané et al, 2013), the present study only considers rural male residents aged between 30 and 65 years who have left their registered place of residence 10

11 and were working for more than one year in Xi an city at the time of the survey. In total, we had 843 valid questionnaires. Measurements In the present study, the prevalence of sexual intercourse is measured by asking: Have you ever had any sexual intercourse in your life? The number of sexual partners was measured by asking How many sexual partners have you had in the past 12 months. Commercial sex experience was measured by asking Have you ever had any sexual intercourse with a sex worker in your life? and How many times have you had sexual intercourse with a sex worker in the past 12 months? Existing research on risky sexual behaviors among male migrants in China considers the frequency of condom use as the measure for unprotected sex (Li Xiaoming et al, 2004;Pan, 2004). In the present research, it is measured by asking respondents how many times they had sexual intercourses without condoms in the past 12 months (with 1=never; 2=seldom; 3=occasionally; 4=often; 5=always). The frequency of condom use at the last sexual intercourse was also used as a measure of exposure to risk of sexual transmitted disease. The factors associated with exposure to risk for sexual health were measured by using questions related to attitudes, subjective norms, use of pornographic materials and knowledge about reproductive health. In this research, Attitude toward exposure to risk for sexual health was measured by asking Do you think that having unprotected sex with a partner is acceptable?, with yes and no as possible answers. Subjective norms consist of one s beliefs about whether close relatives/friends (besides the sexual partner) would feel that they should use a condom or not. They were measured in terms of condom use among members of the respondent social network, by asking How many people around you use condom during their sexual intercourse? with the following 5-point scale as possible answers: 1=none or don t know 2=few, 3=some, 4=many, 5=all ; the higher the score, the stronger the subjective norm perceived by the respondents. The use of pornographic 11

12 materials was measured by asking: Have you ever used pornographic material in your life? As stated above, the frequency of condom use is associated with the individual s relevant knowledge about HIV/ AIDS and STIs (Li Xiaoming et al, 2007; Jung et al, 2009; Fisher et al., 1996). We asked commonly used questions to measure this knowledge, such as Can condom use reduce the risk of HIV transmission when having sex? or Can mosquito bites transmit HIV? Questions were also asked on knowledge of STIs symptoms, such as Do you know if gonorrhea, syphilis, condyloma, herpes progenitalis, venereal ulcer, AIDS, and poradenolymphitis are STIs? Can STIs be identified only by observing sexual organs? The higher the scores, the better is the level of the knowledge about HIV/ AIDS and STIs. To integrate marriage-squeeze and internal migration effects into analysis, three important control variables were included. The first one is age, which is strongly associated with the possibility of getting married, as stated above. We considered two age groups: (the reference group) and 39-65, as 39 years is another important threshold for rural men or rural urban male migrants beyond which chances of getting married is almost zero (Li et al, 2010). The second variable is marital status. While some migrants are single, others are married but migrated to Xi an city without their spouse, mainly because of economic or housing constraints. Therefore, we classified the respondents into the three following categories: unmarried migrants, married but separated migrants (i.e., who are migrating without their spouses), and cohabitating married migrants (i.e., who are migrating with their spouses). In addition, it appeared that 8.4% of the unmarried migrants in the total sample were actually cohabiting with a partner, so we assumed that they have sexual behavior similar to that of married men and merged them into a one category of cohabitating migrants (married or unmarried) (Pan et al, 2004; Huang et al, 2011). The third variable is migration duration. Indeed, existing literature indicates that migration duration might affect migrants attitudes toward marriage, fertility, and sexual behaviors (Wu H.X. and Li S.Z., 2008). Here, migration duration was calculated by asking How many years have you been a migrant? and was included into the analyses as a discrete variable 12

13 ranging from 0 to 38 years. Two other socioeconomic variables, education and monthly income, were also included. Education was measured by asking the highest level of education attained, with the following possible responses: 1 = primary school and below (the reference group) and 2 = high school and above. Monthly income was measured by letting the respondents select one of two categories: 1 = less than 1,000 Yuan (the reference group) and 2 = 1,000 Yuan and above. A preliminary analysis of our survey data indicated that educational and monthly income levels of unmarried male migrants are significantly lower than those of married male migrants, suggesting that bachelorhood among rural urban migrants is strongly associated with poor socioeconomic status, as demonstrated for Chinese rural bachelors (Li et al., 2010). The variables and measurements are presented in table 1. Data processing and analysis The present study uses crosstabs, chi-square tests and independent-sample t-tests to compare the prevalence of sexual behaviors between the three categories of male migrants: never married, married but separated and cohabiting. Our first assumption is that migrant male bachelors have a higher prevalence of sexual intercourse, and that commercial sex is a significant replacement practice to partnered-sex within marriage or stable relationship. The crosstabs and test methods are used to compare the prevalence of sexual intercourse, the number of sexual partners, the frequency of sexual intercourse and commercial sex experiences between the three categories of migrants. Our second assumption, based on the literature review above, is that migrant male bachelors, as they have more frequent unprotected sex with casual partners, face greater health risks during sexual intercourse. Descriptive methods, including crosstabs, chi-square test and independent-sample t-test, are used to make comparisons between unmarried and married male migrants. We used OLS regression to analyze the factors correlating to sexual risks faced by male migrants. The frequency of unprotected sex is used as the dependent variable measuring sexual risk in the regression models, and used as a continuous variable. In model 1, the attitude toward unprotected sex, subjective norms on condom use, the use of 13

14 pornographic materials and the knowledge of reproductive health (HIV/AIDS and STIs) were included as independent variables. Model 2 added the number of commercial sex experiences in the past 12 months and the monthly number of sexual partners in the past 12 months as control variables to model 1. Model 3 added education, monthly income, age, and migration duration as control variables to model2. Models 4, 5 and 6 describe the factors influencing sexual risks among married but separated males, and model s7, 8 and 9 describe the factors influencing sexual risks among cohabiting males. These three groups all share a common strategy for analysis. The block regressions used in this study give a better description of factors correlating to sexual risks among unmarried and married but separated migrants. The estimated coefficients for the independent variables (without the control variables) roughly indicate their impact on the dependent variable. For instance, when the control variables are included in models for forced male bachelors, the pseudo R 2 of the models, which are gradually increased, indicate that the models are better explained when control variables are included, such as age, education et al. However, the strategies of block regression did not give better results for the factors correlating to sexual risk among cohabiting migrant males, due to the unexpected decreased change in the value of pseudo R2s when the control variables are included. Compared to value of R2 in model 7, the value of R2 in model 9 decreased. An reasonable explanation is that cohabiting male migrants can have regular sex with their wives and then have less non-marital sex compared to males who migrate alone (Huang et al, 2011). Therefore, the frequency of unprotected sex among cohabiting males may different from that among males who are migrating alone. Consequently, the strategy of block regressions may not work well among cohabiting males. 5 Results and discussion Sexual behaviors of male bachelors In the present study, the number of unmarried, married but separated and cohabiting male migrants are 88 (10.4%), 576 (68.4%) and 179 (21.3%), respectively. The average level of education of the unmarried men (8.3 years for the younger age-group and 7.7 years for the 14

15 older age-group) is lower than those who are married but separated (8.8 years for younger and 9.4 years for older) and those who are cohabiting with a partner (9.3 years for the younger age-group and 9.4 years for the older age-group ). This significant gap in educational levels by marital status (with t-test= and P<0.01) is consistent with other research on Chinese male bachelors (Attané et al., 2013). The gap in monthly income between married and unmarried man is also significant (with t-test= and P<0.01), which is also consistent with other studies on male bachelors in rural areas (Wei et al, 2008). In our study, 63.3% of the younger male bachelors and 57.1% of the older ones earn no more than 1000 yuan monthly, whereas the proportions of migrants in this income-group are significantly lower among the men who are married (30.8% of the younger and 35.7% of the older among the married but separated man, and 34.0% of the younger and 38.8% of the older among cohabiting men). Existing research indicates that male bachelors in rural areas have less sexual activity (Li et al, 2010). However, the information provided in table 2 shows that the prevalence of sexual intercourse is higher among male bachelors who experience migration: 70.2% of younger bachelors and 48.2% of the oldest have had at least one partnered-sex experience in their life. However, it appears that the prevalence of sexual intercourse among the unmarried is significantly age-dependent (with chi2=4.040 and P<0.01). Compared with male bachelors in rural areas (Li et al, 2010;), those who migrate to the city have a higher monthly frequency of sexual intercourse (with an average number of 2.4 sexual intercourse per month in the two age-groups). However, the frequency of sexual intercourse among unmarried men remains lower than that among the married migrants (3.8 and 2.7 sexual intercourses on the average for the younger and the older married but separated men respectively; and 3.7 and 3.6 sexual intercourses on the average respectively among cohabiting men). Furthermore, our results are consistent with those from other existing studies, which indicate that unmarried migrants usually have more sexual partners than the married due to more frequently casual sexual intercourse (Serovich et al, 1997). Table 2 indicates that the number of partners in the 12 months preceding the survey is higher among the youngest unmarried men (1.5) than among 15

16 both the married but separated (0.7 in the younger age-group and 0.4 in the older one) and the cohabiting men (1.3 in the younger age-group and 1.4 in the older one). Another result is that unmarried male migrants are more likely to experience commercial sex than the married, as frequently noted (Huang et al, 2011). Our study indicates that 41.5% of the younger bachelors and 53.9% of the older have experienced commercial sex at least once. This is confirmed by the statistical analysis that reveals a significant difference in the experience of commercial sex between unmarried and married men (23.4% of the younger and 16.1% of the older age-group among the married but separated, and 22.1% and 20.2% respectively among cohabiting men, with chi2= and P<0.01), a result consistent with Huang s research (2011). The information in table 2 indicates that unmarried men in the older age-group (39-65) have the highest prevalence of commercial sex experience. We can therefore draw the conclusion that commercial sex appears to be a more frequent replacement for partnered-sex within marriage for the oldest unmarried men than for the youngest. Risk for sexual health of male bachelors Male migrants in cities are known to face greater health risks during their sexual intercourse, as they usually have more frequent sexual intercourse with casual partners but without using condom (Li X M et al, 2004). The information in table 2 indicates similar results: First, the frequency of unprotected sex (sex without condom use) among unmarried male migrants in the 12 months preceding the survey is age-dependent (with t-test=1.729 and P<0.1), this frequency being lower among the oldest bachelors (close to never ) than that among the youngest bachelors (close to usually ). Therefore, male bachelors below the age of 39 are the group that faces the greater risks for their health during sexual intercourse Second, in comparison to married men, unmarried males have a lower frequency of unprotected sex (with t-test= and P<0.01): it appears that 34.2% of the youngest bachelors and 46.2% of the oldest used a condom at their last sexual intercourse, compared with only 26.3% and 14.1% respectively among married but separated males and 20.9% and 20.3% respectively among the cohabiting ones. There is also a significant difference in condom use at the last sexual intercourse between unmarried and married male migrants (with 16

17 chi2=9.460 and P<0.01). Another result evidenced by our survey is that the frequency of condom use is higher among the unmarried migrants than among the married who have migrated either with their spouse or partner or not. The explanation probably is that condom is more likely to be used as a device for birth control among migrants who are cohabitating with a spouse or a partner, whereas it is usually used as a protective device against HIV and STIs among unmarried and those who have migrated without their spouse or partner, as stated by Cohen et al. (2009). However, married men are on the average exposed to much lower risks, as they have significantly less frequent sexual intercourse with casual partners and sex workers, and as most of their sexual intercourse occur with the spouse within marriage. Information on commercial sex experiences of male migrants is presented in table 3. Among unmarried males below age 39, they have 5.8 times of commercial sex in past 12 month. Instead, among unmarried males above age 39, they have 5.1 times of commercial sex in past 12 month. This indicates that unmarried have greater number of commercial sex experiences than the married but separated males (4.1 and 4.9 respectively) and those who are cohabiting with a spouse or a partner (3.8 and 4.6 respectively). However, male bachelors above age 39 have only one partner. It can probably inferred that forced male bachelors above age 39, who have to undergo significantly decreasing chance of marriage, have taken commercial sex as the substitute to the legitimate sex that only exist in marriage family. It is also indicates that most of bachelors above age 39 may indeed lose their confidence to get marriage spouse (Yang et al, 2011), with whom they can have marriage sex. Contrarily, forced bachelors below age 39 have nearly two partners in past 12 months previous the survey. Considering the number of commercial sex in past 12 month (5.8) and their sexual active period, they may have other sex partners more than commercial sex workers. Compared with the older bachelors (aged above 39), the younger ones (below the age of 39) face greater risks for their health in their sexual intercourse due to less condom use (58.9% of the younger age-group and 85.7% of the older one have used a condom at their last sexual intercourse), more sexual partners (1.9 for the youngest and 1.0 for the oldest) and more commercial sex (5.8 for younger and 5.1 for older). The information of condom use in the last sexual 17

18 intercourse (table 3) indicated that 58.9% of unmarried bachelors below age 39 have used condom in their last sex intercourse. This frequency is bigger among unmarried bachelors above age 39(85.7%). It indicated that unmarried bachelors below age 39 are more likely not to use condom in their sex intercourse. Except for the less condom use in the last sex intercourse, younger bachelors also have more sex partners and more commercial sex compared to bachelors above age 39. Therefore, the younger bachelors are experiencing higher sexual risks. Influence factors of risky sexual behavior among male bachelors The results of the analysis of the factors influencing sexual risks faced by unmarried men are presented in models 1 to 3 (table 4). In model 1, the use of pornographic material is negatively related to the frequency of unprotected sex (with B= and P<0.05). Unmarried men who have used pornographic materials are less likely to have unprotected sex than those who have never used any pornographic material. When the control variables, including the number of commercial sex and the number of sexual partners, are included in model 2, the value for the use of pornographic material changed only slightly but the direction of the relationship remains unchanged (with B= and P<0.05). What is consistent with our assumption above is that the number of commercial sex experiences has a positive impact on risky behavior (B=0.134,P<0.05). This indicates that unmarried males who experience commercial sex more frequently also have a higher frequency of unprotected sex. Model 2 also reveals that the impact of the use of pornographic material is adjusted by the experience of commercial sex. When including the demographic variables in model 3, none of the significant factors change direction. The impact of the use of pornographic material has continuously weakened (with B= and P<0.1), whereas that of the number of commercial sex experiences has slightly increased (with B=0.136 and P<0.05). Besides, the significant influence of age on unprotected sex (with B= and P<0.1) indicates that the youngest bachelors are experiencing higher risk in their sexual activities than the oldest ones. The three variables included, i.e. the use of pornographic material, the number of commercial sex experiences and age are significant influences on risky sexual behaviors among unmarried male migrants. 18

19 The results of a similar analysis among married but separated male migrants, who serve as a reference population, are presented in model 4 to 6. In model 4, the attitude to unprotected sex has a positive impact on the frequency of unprotected sex (B=0.299,P<0.05). Migrant who have positive attitude toward unprotected sex will have more risky behaviors in their sexual intercourse. Besides, the subjective norm of condom use is negatively related to the occurrence of unprotected sex (B=-0.271,P<0.01). It means that migrants will be more likely to use condom if they know that condom use is usual and popular among their friends. Therefore, migrant will have less unprotected sex if he lives in a circumstance of high prevalence of condom use during sex. What is similar to the factors among forced male bachelors is that the history of pornography use still has a slightly negative impact on the occurrence of unprotected sex (B=-0.311, P<0.1). Including control variables, such as the frequency of commercial sex and the number of sex partners, model 5 shows that the attitude to unprotected sex dose not change direction, with an estimated coefficient of (P<0.05),whereas the impact of subjective norm slightly increases in the same direction (B=-0.274,P<0.01), which is similar to the change of the history of pornography use (B=-0.313,P<0.1). When including demographic variables in model 6, all significant factors, including attitude (B=0.309,P<0.05), subjective norm(b=-0.275,p<0.01) and the history of pornography use (B=-0.437,P<0.01), change in value only. It is noteworthy that the frequency of unprotected sex among married migrants decreases with the increased duration of migration (B=-0.018,P<0.05). Meanwhile, what is significantly different from forced male bachelors is that the older ones among married but separated males have higher frequency of unprotected sex (age, B=0.520,P<0.01). The results of the analysis of the factors influencing risky behaviors among cohabiting men are presented in models 7 to 9. In model 7, subjective norms concerning condom use have a negative impact on the frequency of unprotected sex (with B= and P<0.01). Cohabiting males will have less unprotected sex if they know that there are many friends who 19

20 use condoms during sexual intercourse and vice versa. Knowledge about STIs slightly influences participation in unprotected sex (B=-0.206,P<0.1); male migrants who are cohabiting with a partner will use condom more often during sex if they have a better knowledge about STIs. With more knowledge about STIs, cohabiting males are usually aware of some negative consequences that relate to unprotected sex and will increase their frequency of condom use during sex. Including control variables such as frequency of commercial sex and the number of sexual partners in model 8, the direction of the relationship does not change but the estimated coefficient decreases slightly (at , with P<0.01). This indicates that the impact of the subjective norm concerning condom use has been adjusted by the control variables. Cohabiting males who have more experiences with commercial sex or more sexual partners will behave differently from those who have less experiences with commercial sex and fewer sexual partners, even though they may face the same subjective norm of condom use. However, there is no change in the knowledge about STIs. It means that when control variables are included in model 8, the estimated coefficient of knowledge about STIs didn t change. That the coefficient doesn t change suggests that knowledge about STIs may be a stable factor that affecting cohabiting males frequency of unprotected sex, no matter what their experiences of sexual intercourse. When the demographic variables were included in model 9, the impact of subjective norm is strengthened but the direction remains the same (with B= and P<0.01). However, the impact of knowledge about STIs decreases with an estimated coefficient of (P<0.01) in the same direction. In China, migrant males in different groups by age, income or education, usually have different behaviors. For instance, younger migrant males in China usually have more education and more knowledge about sex. They may be influenced more easily by the subjective norm about condom use than those who have less education and less knowledge about sex. However, the reason for a decreased coefficient of STIs knowledge in model 9 is that part of the impact of STIs knowledge probably comes from education. Among the demographic variables, education is the only factor that has a significant impact on the frequency of unprotected sex among cohabiting males (B=0.101,P<0.1) Migrant males with more education, during which reproductive health knowledge will be acquired, usually 20

21 have better cognition of sexual risks and will convince themselves to use condom more frequently during sex intercourse. This is consistent with results of research that discussed sexual risks among married migrants (Li Xiaoming et al, 2007). From the results mentioned above, it can be inferred that subjective norm of condom use is a key factor that has significantly affected the frequency of unprotected sex among cohabiting males. Education is also an important influence on males STIs knowledge and affects the frequency of unprotected sex. Sexuality and risky behaviors of migrant male bachelors As suggested above, rural bachelors who migrate to cities have higher prevalence of sexual intercourse than those who don t migrate. Existing research has found that many rural male migrants, especially unmarried rural males, are more likely to have sex with strangers, casual partners or sex workers when they migrate to cities. This is partly because they have increased income and social capital through migration (Crosby et al, 2003; Zhang Xuejun et al, 2007). Compared with their counterparts in villages who have limited access to sex partners (Zhang et al, 2009; Li et al, 2010), migrant male bachelors, especially the youngest, have greater alternatives to sex within marriage. It is also observed that the prevalence of partnered-sex among migrant male bachelors is significantly age-dependent, with the youngest ones having had a higher number of sexual partners in the 12 months preceding the survey. Among the alternatives to sex within marriage for the unmarried male migrants in the cities is commercial sex(see table 3). It is noteworthy however that the older male bachelors have a higher prevalence of commercial sex. Besides, they tend to establish the sexual relationships with stable commercial sex workers. Considering the number of commercial sex and nearly only one sexual partner among migrant bachelors above age 39, these bachelors may take commercial sex workers as their stable sex partners. According to the moral norm of marriage sex in China, there is only one sex partner in sex activity. Therefore, the older bachelor may take a familiar sex worker as his sexual wife during his migrant duration. It also appears that the unmarried male migrants, especially the youngest, face greater risks to their health from their sexual activity. In model 2 and model 3, the coefficients of the number of commercial sex in past 12 month are positively significant. It indicated that the frequency 21

22 of unprotected sex will be higher if the number of commercial sex in past 12 month is bigger. The regression results suggest that forced male bachelors will have more unprotected sex if they have more commercial sex. As a matter of fact, most migrant males in China have commercial sex in low-cost erotic places (Huang et al, 2011), where they usually don t use condom in sexual intercourse. These special bachelors are also more likely to have commercial sex in cities than other migrants (see table 2). Therefore, forced male bachelors will experience greater sexual risks during their migration. Results of our research are consistent with a demographic simulation, which showed that sexual risks will increase in the situation of gender imbalance in China due to the shortage of women (Merli et al, 2006). Our results also reveal that forced male bachelors in migration may be the most important spreaders in the spread of sexual risks in China. Considering that the risk of sexual disease infection among migrants will increase if they have sex with multiple partners with no condom use, forced male bachelors below age 39, who have a higher frequency of unprotected sex and more sex partners in last 12 months than their counterparts above age 39, will be the main group experiences sexual risks in cities. Forced male bachelors below age 39 may have sex in other ways such as through adultery or sexual relationship with casual girlfriends. Thus they are not only the potential victims of STIs, but may also spread the sexual risks to other groups. It is noteworthy that even though forced male bachelors above age 39 tend to have commercial sex with a stable sex worker, with whom the sex relationship is more like sex between spouses, they are still experiencing high risks of STIs because the sex workers have to keep sexual relationships with different clients. Generally speaking, forced male bachelors, whether younger or older, all experience high risks during their unprotected sex. The sexual risks among forced male bachelors, including unprotected commercial sex or sex with casual partners, are causally correlated with the gender imbalance and marriage squeeze. On the one hand, forced male bachelors, who usually live in rural areas under disadvantaged socioeconomic conditions, suffer from the marriage squeeze. In villages where the traditional culture is still dominant, they can t have sex due to the primacy of sex in 22