Having multiple sexual partners is associated with beliefs that multiple partners reflect heightened social status in China. These beliefs are also associated with individual sexual behavior risks. Market vendors with normative beliefs about the link between multiple sexual partners and social status were more likely to have multiple sexual partners. This finding is consistent with previous reports about normative beliefs and risk behaviors [35
]. Given that our study used a cross-sectional research design, we cannot make an arbitrary conclusion that the normative beliefs factor was the cause for multiple sexual partners. It is possible that respondents’ normative beliefs about multiple sexual partners are influenced by their personal behaviors. The findings, however, provide support for the hypothesis, based on the theory of diffusion of innovations [29
], that normative beliefs concerning a particular behavior could be one of the primary determinants of the behavioral manifestation. In China, perceived approval of having multiple sexual partners and its relation to higher social status in society appears to influence individual risky attitudes and behaviors. Thus, shifting a community’s social norms regarding sources of status could be an effective intervention to reduce sexual risk.
We also found that having multiple sexual partners was significantly associated with STIs, a finding confirmed in other countries [10
]. However, the normative beliefs were not a significant predictor of STIs after controlling for both socio-demographics and multiple sexual partners. One possible explanation could be that normative beliefs have no direct effects on STIs, but it could affect STIs indirectly through its influences on personal behavior of having multiple sexual partners. Alternatively, some unknown risk factors for STIs not attributed to multiple sexual partners might not be adjusted for in the analysis, and therefore it could confound the effect of normative beliefs on STIs in our study.
This study highlights the role of gender in understanding normative beliefs about multiple sexual partners in China and its relationship with sexual risk behavior. Clearly, both male and female participants were likely to believe that having multiple sexual partners is a sign of high social status more for men than for women. The differences reflected a double standard in male-dominated societies, where female sexuality is more tightly controlled. Under the patriarchal Confucian tradition, Chinese women were the property of men and had few rights—the traditional family structure reinforced women’s marginal status because it was primarily organized around male authority [51
The status of women underwent great change during the 20th century. Some recent studies in China reported that there has been an increase in women who have multiple sexual partners or engage in risky sexual behaviors [12
]. In his study on China’s sexual revolution, Pan [14
] acknowledged the changing attitudes of Chinese women towards sex and further pointed out that, contrary to the perceptions of increased equality, many traditional and gendered assumptions about women’s sexual behaviors remain unchanged. Gender stereotypes often encourage Chinese women to be passive about sex and men to take more risks and assume a controlling role in relationships [53
Gender differences were also observed in light of ambivalent reports on social norms about multiple sexual partners by women, compared to that from men. In this study, women tended to choose “not sure” when asked how other people in their community thought about multiple sexual partners and social status (men were more likely to express their opinions as either “agree” or “disagree”). This can also be understood by the existing gender gap, which led to hesitation in answering questions about sexual behaviors by women in our study. Furthermore, gender socialization theory suggests that women are conditioned from an early age to reason differently from men concerning moral issues and are more prone to the influence of societal norms and values; this tendency was reported to be associated with a higher social desirability bias in women than men [54
]. In this study, there is reason to speculate that social desirability bias played a role in the “not sure” responses, especially for women.
Having multiple sexual partners was significantly associated with higher economic status in this study (measured by more discretionary income). This result was consistent with the findings from previous studies that people earning a high income were more likely to engage in risky sexual behaviors, including commercial sex [4
]. With the rapid economic development that has occurred in China over the past three decades, behavioral norms have changed, including consumption and leisure activity patterns. The marketplace provides opportunities to buy virtually anything for people with higher incomes, and being able to do so becomes a symbol of success. As discretionary money becomes more available to be drawn into the world of entertainment, risk behaviors associated with commercial sex and having multiple sexual partners also become inevitable [55
]. The “second wife” phenomenon in China is considered a part of the sexual revolution in China. Having a “second wife” or “second husband” costs money, and there is no doubt that financial stability plays a role. The rich can afford having more sexual partners, and therefore their risks for unprotected sex and STIs may also increase accordingly.
The generalization of our findings is affected by several limitations. First, the study’s cross-sectional design was limited in evaluating cause-and-effect associations. Second, our results cannot be generalized to all Chinese people, as the sample was limited to only one geographic region of China and with only market vendors. Finally, since having multiple sexual partners was self-reported, the possible bias introduced by under-reporting must be noted.
Nevertheless, this study provides multiple implications for future HIV/STI prevention programs. First, intervention developers should not ignore the social norm component and its relationships to individual behaviors. It is commonly believed that a behavior is more under attitudinal than normative control. Under circumstances in which people identify strongly with their own group, community, or society, norms may have a stronger influence. In a separate study in China, we compared service providers’ perception of social norms and their personal opinions regarding people living with HIV/AIDS and found that reported personal attitudes matched their perceived social norms [56
]. Individuals are a part of a society, and their perception of social norms is built on their interpretations of observations in their personal communities; therefore, their reports on normative beliefs may result from a blend of social reality and personal interpretation. The current findings imply that in order for a risk reduction intervention to be effective, it needs also to intervene on a normative level to make sure that group norms are consistent with the direction of the intervention.
This study underscores the importance to address gender issues in future HIV/STI reduction/prevention interventions. Women’s sexual behavior has become increasingly important in China, in light of the situation that heterosexual transmission of HIV/STI is growing. To reach women as a main force for STIs prevention and intervention, we need to address gender norms and social taboos about discussing sex, and their associations to women’s vulnerability to STIs and HIV transmissions. In future gender-sensitive prevention programs, we should promote mutually respectful and equitable gender relations, and empower women to avoid high-risk behaviors, expand behavioral options for self-protection, and improve access to healthcare and resources that may ultimately reduce their vulnerability to risky behaviors and conditions which cause the spread of sexually transmitted diseases, including HIV.