JMIR Publications

ABSTRACT

Background:

Behavioral differences exist between countries, regions, and religions. With rapid development in recent decades, an increasing number of international immigrants from different regions with different religions have settled in China. The degrees to which sexual behaviors— particularly risky sexual behaviors—differ by religion and geographical areas are not known.

Objective:

We aim to estimate the effects of religion and geographical areas on sexual behaviors of international immigrants, and provide evidence for promoting the sexual health of international immigrants.

Methods:

A cross-sectional study was conducted online with a snowball sampling method among international immigrants in China. In our study, sexual partner types included stable, casual, commercial, homosexual, and group sex, and risky sexual behaviors included having multiple sexual partners, and engaging in unprotected sex. Descriptive analysis was used to analyze the basic characteristics of international immigrants, and their sexual behaviors, religious affiliations, and geographical regions of origin. Univariate and multivariate binary logistic regression analyses were used to identify aspects of religion and geography that were associated with risky sexual behaviors among international immigrants.

Results:

A total of 1433 international immigrants were included in the study. The rates of unprotected sexual behavior were 22.11% (21), 17.63% (113), 8.32% (47), 5.48% (4), 4.26% (2) in non-religious participants, Christians, Muslims, Hindus, and Buddhists, respectively. The rates of having multiple sexual partners were 30.53% (29) in non-religious participants, 27.93% (179) in Christians, 16.64% (94) in Muslims, 16.64% (12) in Hindus, and 8.51% (4) in Buddhists. With regard to geographical region of origin, the rate of unprotected sexual behaviors was highest among immigrants from South America at 30.43% (7), followed by 20.00% (8) for Europe, 17.00% (113) for Sub-Saharan Africa, 15.91% (7) for North America, 14.29% (2) for North Africa, and 7.87% (48) for Asia. The rate of immigrants having multiple sexual partners from South America was also the highest at 52.17% (12), followed by 35.71% (5) for North Africa, 32.50% (13) for Europe, 22.73% (10) for North America, 27.22% (181) for Sub-Saharan Africa, and 15.74% (96) for Asia. Prior testing for STIs/HIV was reported by 29.17% (390) of religious participants and 31.58% (30) of non religious participants. With regard to geographical regions of origin, prior STI/HIV testing was reported by 54.55% (24), 40.00% (266), 39.13% (9), 27.50% (11), 16.89% (103), 14.29% (2) of respondents from North America, Sub-Saharan Africa, South America, Europe, Asia and North Africa, respectively. Compared to sub-Saharan Africans, Asians (AOR 0.613; 95%CI 0.402-0.933) had less probability of having multiple sexual partners and also had less unprotected risk behaviors (AOR 0.562; 95%CI 0.331-0.953). Immigrants with Islam (AOR 0.443; 95%CI 0.226-0.869), Hinduism (AOR 0.256; 95%CI 0.076-0.870) and Buddhism (AOR 0.098; 95%CI 0.012-0.806) were less likely to have unprotected risk behaviors.

Conclusions:

The rates of risky sexual behaviors among international immigrants living in China differed depending on their religions and geographical areas of origin. Sub-Saharan Africans and non-religious immigrants were most likely to engage in unsafe sexual behaviors. It is necessary to promote measures including HIV self-testing, pre-exposure prophylaxis (PrEP) implementation and targeted sexual health education among international immigrants in China.