Sexual health status of women who have regular sexual relations with men who have sex with men in mainland China

Abstract

BackgroundMen who have sex with men (MSM) are a high-risk group for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection. In China, the vast majority of MSM feel forced to marry or plan to marry women, according to traditional Chinese culture. Women who have regular sexual relations with MSM, called tongqi in mainland China, live with a high risk of STDs or HIV infection, but these risks are often ignored. Our investigation of this group of the women is a preliminary study that aims to understand the sexual health problems of tongqi and related factors.MethodsThis study relied on website mobilization and was funded by tongqi. Participants were limited to women who had sex with MSM to whom they were married (in-GWs), whom they had divorced (ex-GWs), or with whom they were friends (GGFs). The data were collected using questionnaire software.ResultsA total 144 valid surveys were returned from 100 in-GWs, 33 ex-GWs, and 11 GGFs. Average respondent age was 32.8 ± 6.4 years (range 22 to 58 years). Among in-GWs and ex-GWs, over 95% learned that their husbands were MSM after marriage. More than half of respondents had had sex before marriage, and one-third of those women had sex partners other than their husbands. In addition, 35.3% of tongqi had STDs symptoms. About 50% participants had had oral sex with sex partners of MSM and 10% had had passive anal sex, with low condom use during both oral (9.7%) and anal sex (23.1%). Most tongqi had misunderstandings about STDs and HIV and less than 30% had undergone HIV screening. Among participants tested, 5.6% were HIV positive. A total 93.5% of respondents believed that laws should be established to protect the sexual rights of women.ConclusionsWomen who have regular sexual relations with MSM face adverse sexual health issues and are susceptible to STDs and HIV infection. Measures must be taken to protect the rights and interests of tongqi in mainland China.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4096-z) contains supplementary material, which is available to authorized users.

Behind the Rainbow, “Tongqi” Wives of Men Who Have Sex With Men in China: A Systematic Review

“…From the database and handsearching 627 articles were initially identified and 11 studies (Tang and Zhang, 2013;Liu and Tang, 2014a;Tang and Liu, 2014;Tang and Yu, 2014;Zhang et al, 2014Zhang et al, , 2015Li X. H. et al, 2016;Li et al, 2017;Wu et al, 2018;Yan et al, 2019) met the selection criteria and were selected for the review (see Figure 1).…”

“…Tongqi in China are a high-risk population of HIV and sexual transmitted diseases. For instance, Li et al (2017) reported that in a sample of 144 Chinese gay wives, less than 30% had undergone HIV screening and 5.6% were HIV-positive; furthermore 35.3% had sexually transmitted infections (STIs). The literature was inconsistent with reporting wives' use of condoms during sexual intercourse with their husband.…”

“…The literature was inconsistent with reporting wives' use of condoms during sexual intercourse with their husband. Li et al (2017) found that 60% of the wives would use condoms during intercourse with their husbands. found that 40.2% never used condoms with their husbands, and 47.6% of these wives who never used condoms were at high risk of contracting HIV.…”

“…Considering the population size, China is home to the world's largest homosexual population (Wang et al, 2019). However, homosexual marriage is not recognized by law in China (Marriage Law of the People's Republic of China, 2001;Li et al, 2017). In China, due to discrimination, men who have sex with men (MSM) are a sexual minority and remain hidden as a population (Zhu, 2018).…”

“…Recently, increasing concerns have been raised regarding the welfare of wives of MSM . Noticeably, Tongqi suffer from profound intimate partner violence (IPV, i.e., physical abuse, verbal abuse, and emotional abuse), suicidal ideation, suicide attempts, depressive symptoms, anal sex coercion, and at risk of sexual transmitted diseases (Liu and Tang, 2014a;Li et al, 2017;Wu et al, 2018).…”