Lifetime commercial heterosexual behavior among HIV negative elderly men from rural Chengdu, China: a modified knowledge-attitude-practice perspective

Background China is facing big challenges to achieve the “90–90-90 targets”. The HIV prevalence of elderly (≥50 years) men have been steadily increasing in China, mainly through the sexual transmission route, but sexual behaviors of them are far from well-studied. In 2019, elderly men accounted for 59.2% of HIV/AIDS cases in Sichuan, China. Methods The research design is a cross-sectional study. Face-to-face interviews were conducted among 795 HIV negative elderly men from rural Chengdu, capital City of Sichuan. Bivariate and multivariate logistic regression models were applied to examine factors associated with commercial heterosexual behavior from a modified Knowledge-Attitude-Practice (KAP) perspective. Results 129 (16.23%) respondents admitted high-risk sexual behaviors, including 11.07% commercial heterosexual behavior, 6.16% extramarital, 2.89% casual and 0.25% homosexual behavior, and no one used condom consistently. 427(68.43%) had ever gotten HIV-related Health Education (HRHE), mainly through mass media (70.49%). The HIV-related knowledge awareness rate was only 31.41%. Migration history (AOR =2.46,95% CI = 1.02–5.91), age(≥60 vs. 50–59, OR = 0.41, 95% CI = 0.19–0.91), receiving HRHE from mass media (OR = 0.37, 95%CI = 0.16–0.85), marital status (married vs. never married, OR = 0.04, 95%CI = 0–0.52), and undecided (AOR =0.02, 95%CI = 0.01–0.09) and objection (AOR =0.04, 95%CI = 0.01–0.1) attitude toward commercial sex were related to lifetime commercial heterosexual behavior. Conclusions High-risk sexual behaviors are common among elderly men from rural areas in Chengdu. Receiving HRHE from mass media and undecided and objection attitude toward commercial sex prevent elderly from being involving in commercial heterosexual behavior. According to the results, health facilities should continue to conduct systematic interventions, paying more attention to 50–59 years old group. Sex and condom use need to be talked in public. Working with mass media, health facilities give elderly men education not only focusing on HIV/AIDS, but also on knowledge and skills of condom use.

Sports and Sexuality

This chapter explores the intersection between athletic practices and sexual expression, primarily in the Western world, beginning with the same-sex eroticism of gymnasia in ancient Greece and the charged atmosphere of gladiatorial contests in Rome. After brief mentions of jousting and the Renaissance celebration of chiseled torsos, the chapter focuses on sports’ nineteenth-century reemergence as a chaste antidote to sexual desire, particularly in the movement known as “muscular Christianity.” Already by the early 1900s, however, athletes had begun to cultivate highly sexualized images. The heavyweight boxer Jack Johnson, in particular, epitomized white fears of the athletically indomitable and sexually insatiable black athlete. Even as heterosexual behavior in sports became headline news in the twentieth century, homosexuality remained hidden in the shadows until the first female tennis players began coming out in the 1980s. The chapter concludes with the rise of the athlete as sex symbol over the past three decades.

Pediatricians and Gay and Lesbian Youth

The Epidemiology of Adolescent Homosexuality PREVALENCE Sexual orientation refers to an individual's pattern of physical and emotional arousal toward other persons. It is not synonymous with gender identity (the knowledge of being male or female) or gender role (outward expression of maleness or femaleness). Gender identity and gender role generally are defined by anatomic and chromosomal gender in both heterosexual and homosexual individuals. Sexual orientation also is not synonymous with sexual activity; many homosexual individuals, especially during adolescence, participate in heterosexual behavior and relationships,1,2 and many adults who identify themselves as heterosexual report homosexual activity during adolescence.3-5 It is difficult to know with certainty the number of people who identify themselves as exclusively or predominantly homosexual. It is more difficult still to estimate the number who have questions about their sexual orientation during adolescence because of the well-known fluidity and complexity of sexual attractions and activities during this period. The original Kinsey study of sexuality reported that from puberty to age 20, 28% of boys and 17% of girls had one or more homosexual experiences. The same survey reported that 37% of adults have had homosexual experiences and that 10% consider themselves to be predominantly homosexual.3,4 In a somewhat more recent cross-sectional study of 13- to 19-year-olds, 11% of boys and 6% of girls reported at least one homosexual experience, with 17% of boys aged 16 to 19 reporting such activities.6