Changing attitudes and HIV risk behavior among youth in Kunming, China

Background: A qualitative study was conducted among youth (ages 15-24) in Kunming, PRC to obtain information about sexual and drug use risk behaviors for HIV. Methods: Twenty-three dyad and triad interviews were conducted with 59 unmarried vocational school and migrant youth that visit entertainment venues at least twice a month. Analysis was conducted using a thematic transcript-based strategy. Results: Social norms among youth are changing in Kunming; increasing acceptability of premarital sex is reflected by growing numbers of casual and regular partners prior to marriage. Despite increased sexual activity, condom use remains rare and socially stigmatized. Carrying condoms or suggesting their use connotes promiscuity, unwillingness to commit to a partner, or untrustworthiness. Perceived risk of sexually-transmitted infections is low. Alcohol and the increasing use of illicit “party” drugs (ketamine, ecstasy, methamphetamines) provide additional obstacles to responsible sexual decision making. Injecting drug use was rarely mentioned, indicating that the primary focus of HIV prevention efforts targeting urban youth should address sexual transmission. Conclusions: Limited in-school sex education, adults' embarrassment to discuss sexual topics with young people, and an unsupportive social environment for condom use are a dangerous combination that could fuel future sexual transmission of HIV in China. To address these issues, youth program messages should focus on normalizing and encouraging condom use as a responsible decision in addition to encouraging abstinence and partner reduction. Moreover, young men appear to be the ultimate decision makers for condom use and should constitute the primary target for campaign materials.