Understanding the meaning of short-term, yiyeqing relationships and how they are formed: Implications for condom use in Liuzhou, China

Abstract

Yiyeqing (“one night love”, i.e., having sex only once with a non-commercial partner) has increased in China, concomitant with the increase in heterosexual transmission of STI/HIV. Our study explored how participants who had experienced yiyeqing (YYQ) understood these relationships and characterized YYQ’s links to sexual risk behaviors. We conducted in-depth interviews with 45 adults in Liuzhou, a city in southwest China, who had YYQ experience. We analyzed the findings using social construction to interpret the participants’ understandings of YYQ. Participants reported that they tend to select YYQ partners whom they trust, which is built through introductions from social connections and within entertainment venues, resulting in the belief that their partners are free of STI/HIV and do not require protected sex. As YYQ relationships become more common, understanding the nature of these relationships is critical for developing public health messages that convey the risks associated with sex in short-term relationships and the need for condoms.

INTRODUCTION

In the past 30 years, China has experienced a dramatic shift in patterns of sexual behaviors, relationships, health and related policies (¹), including increases in the numbers and types of sexual partnerships (²). “One night love,” a term we use in our research to refer to sexual relationships that only occur once with a non-commercial sex partner, has increased significantly within the last decade (³). There is no agreed-upon phrase in Chinese for describing this behavior, although “one-night-love,” from the Chinese, yiyeqing (YYQ) has recently emerged in the popular lexicon, particularly on internet sites and magazines for entertainment and for sexual health (e.g., ^4–10). The varying characteristics associated with the patterns of YYQ behavior and how YYQ has increased significantly in the last decade in China are only beginning to be elucidated (³). In a survey of young and middle aged adults in four Chinese cities, 77.8% reported that they would like to have YYQ (¹¹), suggesting that it is becoming increasingly popular. For those with YYQ experiences, men are more likely to report having YYQ than women and have their first YYQ encounter at a younger age than women (^8,12).

Few studies have addressed the influence of the rise in YYQ on STI/HIV transmission. Official estimates in 2011 reported that 780,000 Chinese residents were living with HIV, and 62% of new cases were attributable to heterosexual sex, compared to 32% in 2006 (¹³). Although YYQ may increase the chance of STI/HIV transmission, we know very little about the impact of YYQ relationships on STI/HIV risk. Some evidence supports the association between short-term sexual relationships and risk. For example, STI clinic attendees who reported casual sex were more likely to be diagnosed with an STI (^14,15). One of the major gaps in our understanding of the link between YYQ and the heterosexual spread of HIV in China is the limited investigation of the safer sex practices used in these short-term relationships. Evidence of condom use during short-term sexual relationships has been mixed in non-Chinese settings; in some studies individuals state the importance of condoms but do not use them in short term relationships (^16,17), while in others, couples are more likely to use condoms in short-term relationships (^18–20). Understanding the extent of the risk of STI/HIV transmission in China during YYQ has important implications for public health prevention.

This study explores YYQ behavior from a social construction theory perspective (^21,22) by soliciting how sex is a behavior that is defined and shaped by specific social and historical contexts (^23,24). According to Pan and Huang (²⁵), people use interpretations of their environment and past experiences when applying labels and meanings to their sexual behaviors. Social construction theory allows us to recognize that identical sexual acts have varying social and personal significance depending on the particular historical or cultural context in which the sexual behaviors occur. This approach emphasizes understanding the subjective meanings that individuals construct to interpret their experiences with sex and sexuality. For this study, we asked people to describe the relationships they label as YYQ without imposing a definition. We explore how people understood YYQ based on the trust they developed with a YYQ partner, how their YYQ partnerships were facilitated through social connections and socializing at entertainment venues, and how trust through feeling close and familiar with a YYQ partner affected safe sex practices.

In the last 20 years, many Chinese terms have emerged to describe short-term sexual relationships. Historically, a word to describe these relationships has not been a part of the Chinese lexicon, so language has been introduced from western countries to label these relationships as they become more common. The Chinese media is primarily responsible for the popularization of the term yiyeqing (YYQ), directly borrowed from the English, as a loose translation of “one-night stand”. The slang term “419” emerges from the slight modification to the pronunciation of the English phrase “for one night”. However, in contrast to the connotations of “one-night stand,” which in English suggests a short-term sexual relationship with a stranger, local understandings of YYQ in China seem to have resulted in an array of broader meanings to describe any casual sex which occurs once with a partner.

The public health response in China has targeted the occurrence of YYQ, so that media and health messaging related to HIV prevention incorporates information about the risks of YYQ. Thus, these brief relationships are widely referenced in China as YYQ or 419, but the terms used in health messages are rarely, if ever, defined. We have poor understanding of the nature of the sexual behaviors that occur within YYQ relationships, and we know little about how YYQ is understood by people engaging in the behavior. The purpose of this study is to explore the sexual practices and meanings that Chinese people ascribe to YYQ and to examine how people experience, characterize, and subjectively construct their YYQ behaviors in relation to the social relationships that they share. Further, we explore how participants’ interpretations and beliefs of their YYQ partners may be linked to sexual risk behaviors, condom use in particular, that can spread HIV.

METHODS

Research setting

We selected Liuzhou, a city in southwestern Guangxi Province, with a population of 3.7 million, and a high prevalence of STI and HIV (²⁶) as our research site. This study is part of an investigation of the characteristics and behaviors of patrons at entertainment venues where people meet new sexual partners. In 2009, we identified venues in Liuzhou using the Priorities for Local AIDS Control Efforts (PLACE) method to characterize places where new sexual partnerships are formed (²⁷). Findings from a 2009–2010 survey of a stratified random sample of female workers at these venues have been published elsewhere (²⁸).

Sampling and recruitment

From August-November 2011, we approached 65 people for in-depth interviews on YYQ; 45 agreed. We identified people who had YYQ experiences through: 1) a convenience sample of participants (n=11) reporting YYQ in the survey collected during the PLACE parent study whom we interviewed at the entertainment venue on the same day; 2) a convenience sample of participants (n=27) referred by physicians engaged in STI/HIV prevention outreach activities whom we contacted and typically interviewed within one day; and 3) a snowball sample from previously interviewed participants who referred others who had YYQ experience (n=7) and whom we interviewed within one day. Eligibility criteria included: living in Liuzhou at least five years; having self-reported non-commercial YYQ; and being age 18 years and older. Our approach was to introduce the topic of our project using “yiyeqing,” to ask participants to describe relationships as they self-defined them. Throughout the paper, we use the term YYQ to emphasize our intent to explore its subjective construction in the Chinese context.

Data collection

Two of the authors, who are trained social science researchers, conducted the in-depth interviews. Each of the 45 interviews occurred one-on-one in a confidential location. To build rapport prior to starting the interview, interviewers met with participants in a coffee shop or restaurant before moving to a private space.

After explaining that the interview was anonymous, we collected verbal informed consent. With participant permission, we recorded most interviews (n=38). For the remainder who did not agree, we took notes during the interview which we immediately expanded after the interview to recreate as much of the conversation as possible. The interviews lasted between 30 to 120 minutes. We started the conversation simply as “do you have experience with YYQ?” to avoid imposing our own definition, so that the participants could describe any relationship that they identified as YYQ. During the interviews we collected other information from participants about their experiences of YYQ and how they understood its meanings. Specifically, we asked about their YYQ experiences; where and how they met YYQ partners, including entertainment venues; sexual behaviors during YYQ; how YYQ is influenced by social relationships; and their overall understanding of YYQ. Participants received 100 RMB (about $16) after the interview. The research was approved by the Renmin University of China IRB.

Data management and analysis

The first author transcribed the interviews in Chinese, analyzed the Chinese transcripts using ATLAS.ti, and translated quotations into English for this article. For the analysis, the first author created a deductive code list according to the topics in the interview guide in order to identify emergent themes and patterns in the data using content analysis (²⁹), and to develop and apply inductive codes. As a team, the authors interpreted the codes to compile the findings and identify meanings of the results presented. We altered participants’ names and some personal details to protect identities and maintain confidentiality.

RESULTS

1. Participant characteristics

Table 1 presents the demographic characteristics of the 45 participants. We interviewed equal numbers of men and women to discuss their YYQ experiences, ranging in age from 18 to 60, with an average age of 39.5. Approximately half the participants were married, the rest were never married or divorced. Most participants had between 2 and 10 YYQ partners, although one participant reported more than 300.

Table 1.

Demographic information of participants (n=45)

Demographic Characteristics	Number
Gender
Male	23
Female	22
Average age	39.5 [range 18 – 60]
Marital Status
Never married	16
Married	21
Divorced	8

2. Defining YYQ relationships

When defining YYQ relationships, participants described numerous criteria. The most important was that YYQ partners only have sex once, even if one member of the partnership might have anticipated a longer-term sexual relationship. In addition, most participants agreed that: 1) there is no payment required to have YYQ, although gifts or money may be exchanged as part of the relationship; 2) YYQ partners may be familiar or unfamiliar, ranging from friends and colleagues to internet friends, acquaintances, and strangers; 3) the majority of YYQ partners meet through shared social connections or in a social venue; 4) YYQ sex typically occurs at night, especially when partners meet at an entertainment venue; 5) YYQ relationships may involve an emotional attachment in addition to sex; and 6) partners participate willingly and consensually. Our participants excluded commercial sex partners and long-term sexual relationships from their understanding of YYQ.

Of these characteristics of YYQ relationships, we found that the social proximity that partners shared prior to YYQ – that is, partners who were familiar to each other personally or through their social connections – was a key factor in their descriptions of these partnerships and how they characterized their YYQ partners. The participants’ reports on length of the relationship prior to YYQ ranged from having a long-term or short-term relationship with shared social and personal connections to having no previous relationship nor sharing any obvious social connections. Reporting a close social proximity to a YYQ partner prior to sex suggests that partners have known each other for a longer length of time; the opposite, however, may be equally plausible—that some participants used their social connections to feel closer to a newly met partner.

Of participants who reported being familiar with a YYQ partner for a long time prior to having sex together, Jianguo (male, 26 year old, unmarried, white-collar worker) is an example. His YYQ partner was his English teacher. They had known each other for at least a year, liked each other, however, his teacher was married and they had not communicated their feelings. During his graduation party, Jianguo drank a lot of alcohol. He told her that he liked her, and they had sex in a hotel. Soon after, Jiangou moved to another city for work and lost touch with his teacher, ending the relationship. Having this type of long-term non-sexual relationship prior to YYQ helps to build closeness, often including an emotional connection, which helps partners trust each other during YYQ. In other examples, participants described creating opportunities to share social activities together that may lead to YYQ. Xiaoyan (female, 39 years old, divorced, business woman) had played mahjong with friends for several years. One of these friends became her YYQ partner one evening after playing mahjong and getting drunk together. Feeling lonely and desiring sex, Xiaoyan ended up at a hotel with the man, and they had sex without a condom, a relationship that Xiaoyan regretted because “he is too old and ugly, I don’t like him.”

Participants also described having YYQ with people whom they had recently met in their social group. This was reported as often as having YYQ with a better known person. Because they shared a social connection, even though the partner was previously unknown, participants often felt close and trusted these YYQ partners. Many were like Mei Zi (female, 20 years old, unmarried, student) who found a YYQ partner through socializing with friends at an entertainment venue. While out with her school friends, one introduced her to a 40-year old man who was known as the “venue teacher” (yedian laoshi) because of his reputation for drinking, dancing, playing, and singing at the venue. Mei Zi took an interest in him because of his familiarity with the venue and her friends’ familiarity with him. After drinking, dancing and using drugs together, Mei Zi had YYQ with him. In contrast to her experience, a few other participants reported that meeting a YYQ partner through social connections was not enough to feel that the partner was safe and trustworthy. Lili (female, 20 year old, unmarried), a cosmetician who worked for venue sex workers, believes that people always sleep with many partners, making sex unsafe. With her YYQ partner, even though “he is my friends’ friend,” she had “just met him,” which was not enough to build trust for having unprotected sex. In cases like Lili’s, short term relationships do not allow YYQ partners enough time to know each other, and evidence is lacking to judge whether their partner has a good personality, a trustworthy occupation, and stable emotions. This is information that helps create comfort with a YYQ partner.

Some YYQ happens between strangers with no known social proximity prior to sex, although this was not common among our participants. For these individuals, little socialization is necessary for YYQ partners who are strangers prior to sex beyond establishing that the partners want to have sex. The primary purpose of YYQ with a stranger may be for sex only, with little interest in getting to know the partner personally. In these cases, participants discussed not trusting each other, which leads to more condom use with these YYQ partners. For Da Qiang, picking up a woman in a bar for sex meant that he chose to protect himself:

I think of her as a stranger to me, we slept together only for sex… I don’t trust her [to not be infected with STI/HIV]. I think she doesn’t trust me either. We are people who hang out in bars… haha… we used condoms. (Da Qiang, male, 40 year old, married, businessman)

However, YYQ with a stranger may be driven by more than the desire for sex. For example, Yangfen met a man during a low point, which resulted in YYQ without a condom:

My husband drank and he beat me when he got home. We had a big quarrel. Afterward I went out and did not want to return, but I didn’t know where I could go. I just walked along the road and it was midnight. A man driving a car stopped in front of me and asked me whether I need help. I said no, and continued to cry. He asked me to get in the car and we went for me to eat something. He was very kind and I told him why I was crying. After eating, I still didn’t have any place to go, so he got a hotel room for me. I was touched by his gentlemanly behavior. We had YYQ during that night. We did not use a condom because he was too kind and I felt shy to ask him to use a condom. (female, 35 years old, factory worker, married).

3. The role of social groups and entertainment venues in facilitating YYQ relationships

When talking about how they met YYQ partners, most participants discussed the importance of socializing together to establish their desire to have sex with one another. We learned that the two main facilitators for socializing with potential YYQ partners were sharing a connection within a social group and socializing together in the same entertainment venue.

Shared social group connections with YYQ partners

YYQ relationships often involve making a connection with someone who is a member of the same social group. Relationships, with friends, classmates, neighbors, and co-workers, facilitate the social group activities that lead to meeting people who become YYQ partners. Our participants discussed a variety of events where they met their YYQ partners, including friends’ birthday celebrations, work parties, dancing in a nightclub, and hanging out in an internet chat room. The YYQ partners may be members of the same social group, or the social group may engage together in social activities which makes it easy to meet new people who are not necessarily members of the social group.

Participants described dynamic social groups, meaning that the groups are receptive to new members, with people freely entering and leaving the group. Even within the same social circle, participants were able to meet new friends and potential YYQ partners as the group dynamics evolved. For example, Jianguo often met new business clients from his work connections:

My second YYQ partner was my business client, she always contacted me for business, over time we became familiar with each other. One night she invited me for dinner; we drank alcohol and talked a lot. She said she liked me. After dinner, she drove us to her house. I did not refuse. Then we had sex. (male, 26 years old, unmarried)

Membership in a social group may result from shared interests, experiences, or hobbies, which facilitate contact with potential YYQ partners, as described by this participant:

Many of my friends are photography enthusiasts. One time we went to a sightseeing spot for taking pictures and stayed in a local guesthouse for the night. The owner of that guesthouse was a nice girl… she was my YYQ partner. (Li, male, 31 year old, married, government officer)

Socializing in venues with YYQ partners

Entertainment venues, such as KTVs, karaoke bars, or nightclubs, play a critical role in facilitating social interactions with potential YYQ partners, often while in the company of friends or business colleagues. Dancing, singing karaoke, and drinking alcohol are popular activities in venues. In addition, substance use is popular in venues, where drugs like ‘K fen’ (ketamine) and ‘shen xian shui’ (GHB) are common. Although very few participants spoke of using drugs themselves, some discussed drug use in the venues and drug users as potential YYQ partners.

Most participants found YYQ partners when they were with their social group in the venues rather than going alone. While in a venue, group members are directly or indirectly introduced to their YYQ partners through their social connections. Many participants had experiences similar to Xiao Bai (female, 25 year old, clerk, single) who described going to a night club with a big group of friends, one of whom introduced her to her YYQ partner who was also at the club.

Some participants explicitly discussed attending venues with friends to search for partners with whom to have YYQ, suggesting that venue norms and expectations facilitate YYQ. Juan (female, 45 year old, divorced, hairdresser) often went to night clubs with friends because she felt the venue environment is conducive to meeting new people via intimate dancing, low lighting and suggestive music. As she said, “many sexually active men and women dance close there, some men always look for sexual partners in those places…I think everyone knows that people may find some relationships there.” Juan found her YYQ partner through a friend after drinking too much in a venue.

The interviews documented how important alcohol is within this environment to enhance the time spent socializing at venues and to help reduce sexual inhibitions. Drinking is encouraged among friends in venues, particularly through games that increase consumption. Participants related events like Jian Gou’s story (male, 26 year old, unmarried, white-collar). He drank and danced with an old acquaintance while at a friend’s party in a KTV bar. Alcohol gave him the courage to be physically affectionate with her. When the woman was persuaded by his advances, he continued and they ended the night having sex.

Drugs used in the venues also promote sexual activity while inhibiting safe sex considerations. Some participants experienced YYQ with drug use, such as Tian Shu, who often gathers with friends in a KTV room to take ‘K Fen’. Once after getting high, he had YYQ in the bathroom of the KTV with a woman who shared a mutual friend in their social group:

I took too much K fen with friends in a KTV room. I was too high to control myself. At that time I was thinking that the whole world was mine…I really needed sex, then I had sex with a girl in bathroom (of the KTV)…A condom? I could not find it at that moment…I think the K fen was working on me. (male, 20 year old, unmarried, businessman)

Some participants reasoned that the excuse of “tai wan le” (too late to go home) when the venues are still open makes YYQ easier. For example, Jia Bao (male, 38 year old, married, factory worker) met a beautiful woman while dancing in a bar. As the night proceeded, they danced in the venue, and only after all his friends left did he ask her to have sex with him. Likewise, some of the female participants who were students explained that staying out late justifies having YYQ because “it is too late, my dorm is closed, I have no place to go, so I went with him” or “it is midnight, I was too drunk to go home, he brought me to a hotel and we had YYQ.”

Subjective Construction of YYQ and its Influence on Condom Use

Thus far, we have highlighted a number of factors that influence how participants define YYQ based on how the partners meet. YYQ relationships often depend on sharing a connection to a social group or socializing together in the same venue. YYQ partners are typically not strangers; many of our participants discussed YYQ relationships with someone who is well known or with whom there is some social connection, such as an old friend, colleague, acquaintance or a potential boyfriend/girlfriend. Importantly, participants tend to trust YYQ partners with whom they have such a personal or social connection, especially when it comes to evaluating sexual risk and determining whether to use condoms. The connection through their social group may develop before and/or continue after YYQ. This familiarity with their partner encourages trust, and, as a result, many participants did not report using condoms. Their degree of confidence that their YYQ partner is free of STI/HIV was often contingent on the strength of the personal or group connection to the partner. For instance, when Jianguo talked about having sex with his high school teacher, he felt he did not need a condom because they already knew each other:

We drank a lot at the graduation goodbye party. I became very brave and told her that I liked her......I didn’t use a condom with her. She was a teacher of mine for three years. I didn’t think she was a bad woman. (Jianguo, male, 26 year old, unmarried, white-collar worker)

For many participants, the shared connection to a social group inspired trust, which, in turn, lessened the perception of risk. The choice to use condoms depended on participants’ experiences and beliefs about safe sex and who might be trustworthy as a partner, as well as overall concerns about sexually transmitted infections. For example, Dashu, who drove a motorcycle taxi (an illegal business in Liuzhou), associated STI with sex workers only, so he often had unprotected YYQ with women he taxied around for the day after getting to know them and judging them to be safe. In contrast, Lili discussed moving through sexual partners quickly, having more than 300 YYQ partners. She reflected on her reasons for condom use with a YYQ partner who was part of her social group but whom she did not personally know very well:

He is my friends’ friend. During that day, we had dinner, then coffee, karaoke…he said he liked me. We finally had YYQ during that night......we used a condom…because I had just met him, I have to be careful with this. I will die if he spreads STI to me. (Lili, female, 20 years old, unmarried, cosmetician)

Sexual behaviors are influenced by how well participants knew their YYQ partner and also by their expectations for the relationship. Participants discussed short- and long-term expectations that they have for the sexual and emotional aspects of relationships with their YYQ partners. The more serious the desire for a relationship, and the greater the emotional and sexual bond, the less likely they were to use a condom during YYQ. Li, the government officer who went on a photography trip, enjoyed his time with the owner of the guesthouse where he stayed. Later, they met in Liuzhou where they had YYQ. Because Li considered the sex as a demonstration of love for her, they did not use condoms. Soon after, the guesthouse owner ended the sexual relationship because Li was married:

I thought of her as my lover. I know she is not a bad girl [not promiscuous nor uses drugs] …so we didn’t use a condom. (Li, male, 31 year old, married, government officer)

Considering a YYQ partner as a boyfriend/girlfriend or future spouse were offered as reasons for participants to avoid condoms. Some did not think they were having YYQ because they regarded their partner as a potential long-term relationship, observing, “you want to be in a long-term relationship with someone, but you end up having YYQ.” Some reported that they continued dating their YYQ partner for a short time without further sex before eventually breaking up, while others had YYQ after dating for a while, but never saw each other again afterward. Weiwei had friends who did not want her to be lonely after her divorce, so they introduced her to a potential “boyfriend” who was a married man. They spent time together for several weeks; when they had sex, they did not use a condom because Weiwei considered this man as her boyfriend, even though she knew he was married. After YYQ, the man never contacted her again. She was left angry, feeling that he had not respected her emotions.

We didn’t use a condom. Have you heard of anyone who uses condoms with their boyfriend? (female, 40 year old, divorced, factory worker)

A few participants had YYQ to meet sexual desires without any emotional attachment. In these situations, participants reported using condoms, which was related to lack of trust. One night, Bao (male, 25 years old, unmarried, clerk) went drinking with his male colleagues at a venue to unwind after work. They made a bet over who could find someone for YYQ, so Bao invited women over to drink and chat at their table. At 3am when they finished drinking, Boa asked one woman to have sex with him and she agreed. They had YYQ at a hotel and they used a condom because Bao was worried about getting xing bing (STI) from someone he did not know well.

Some participants weighed using condoms based on the occupation and social status of their YYQ partner. A partner with the high status of a “regular job” (zhengjing gongzuo) was thought to have a disease-free (mei bing) status. Participants defined a regular job as “decent” and “legal” (such as, teachers, doctors, factory workers, or business people), as opposed to those in illegal occupations (such as gamblers, sex workers, or drug users). For example, Wang (male, 53 year old, self-employed, divorced) described his YYQ partner as a doctor, and reasoned that medicine is a “clean occupation” and doctors should have professional knowledge about how to prevent the spread of STI/HIV. Therefore, he did not use a condom with her.

When partners were judged to be “safe” or “trustworthy,” participants mentioned condoms as useful for preventing pregnancy, although none of our participants reported personal experiences using condoms during YYQ to prevent pregnancy. One female participant, Yue Jie (35 years old, married, housekeeper), who was unhappily married and often socialized with friends in KTVs, said that because she already had an IUD to prevent pregnancy, she did not think that condoms were necessary.

When asked, participants said that they did not pay money to have sex with YYQ partners. Rather, forming YYQ relationships is motivated first by sexual attraction, and second by an emotional attachment. However participants described other financial transactions that accompanied YYQ, such as buying dinner drinks, paying for the hotel room, and purchasing transportation home. Even though money or gifts may be exchanged, participants did not consider this payment, but rather a sign of affection. The distinction about payment helps make YYQ “safe” and differentiates it from the perception of greater STI/HIV risk when sex is purchased. Paying money tarnishes the experience by linking it to the immorality, stigma, and fear of STIs associated with sex work.

I won’t give money to her. If I did, then the nature of this [YYQ relationship] is changed. I can spend money on dinner, travel and hotel, but I never pay her for YYQ. (Lao Xu, male, around 30 year old, unmarried, businessman)

In contrast, the few participants who explicitly reported buying sex from a commercial sex worker used condoms. For example, as Li Qing describes:

I just need sex, so I buy it from that girl. Sex for her is just business. We don’t trust each other about STI, so both of us agree to use condoms.” (Li Qing, male, 28 year old, single, government officer)

DISCUSSION

The participants’ experiences with YYQ detailed in this study provide an overview of short-term relationships formed for a single sexual encounter. In other settings, studies have defined “one night stand” as immediate sexual gratification with a stranger that occurs once at night and typically without responsibility to the partner (^30–32). Although such sexual encounters were considered to be YYQ, participants in our study described more elaborate combinations of social, emotional, and sexual attachment for their YYQ relationships. Numerous types of relationships were considered YYQ, as long as they only had sex once and excluded payment for sex.

As the sexual revolution in China has evolved in recent years, people are forming YYQ relationships at a time when sexuality is becoming more open (^1,2). National survey data reveal that sex between acquaintances accounts for nearly half of YYQ (³³). We found that sites where friends and acquaintances have the opportunity to socialize clearly facilitate YYQ relationships. While socializing may be the initial driving force underlying attendance at venues, venues— as popular socializing locales—also reinforce social relationships. Likewise, social relationships continue to bring activities into venues that support their business. Complex social situations caused by these intersections influence peoples’ perceptions and sexual behavior, including YYQ. Several studies have found links between visiting entertainment venues and HIV/STI transmission (^34–36). As we document, this association is likely assisted by increased use of alcohol and drugs, which enables meeting YYQ partners and reduces condom use (^35,36).

Within YYQ partnerships, protected sex is uncommon for a variety of reasons. Participants reported not using condoms because of the trust established through shared social connections, expectations for a long-term relationship, loosened inhibitions facilitated in entertainment venues, and the positive assessment of social status and other aspects of “safety.” Trustworthy people were given primacy as potential YYQ partners, while building trust with casual YYQ partners was important for the participants. As a result, most participants in this study were unconcerned about the potential risk of STI/HIV from YYQ without a condom.

Developing trust in sexual relationships as an alternative to using condoms for STI/HIV prevention is a well-established phenomenon in other settings (^37,38). However, trust typically is built over time with a long-term partner and is not well-documented among casual partners. What is unique about our findings is the role of trust in selecting YYQ partners as a strategy participants used to protect themselves. Participants discussed having YYQ with complete strangers far less often than with someone with whom they were familiar, but when they did have YYQ with a stranger, they also used strategies to assess the partners’ trustworthiness – such as finding out if they had a respectable job – in order to avoid using condoms.

Our study has several limitations. First, we had difficulty recruiting participants of high social status because they were worried about confidentiality, and some young people in the venues declined because they were too busy socializing. Second, though our team has experience conducting research on sexuality and worked to establish rapport with our participants in confidential settings, it is likely that there are sensitive aspects of YYQ experiences that participants did not share. Finally, given the gap in knowledge about YYQ in China, many of our findings are preliminary.

Implications for Interventions

Our research indicates that sexual behaviors aided by social connections and entertainment venues, such as YYQ, need to be explored as potential risk factors that contribute to the heterosexual spread of STI/HIV in Liuzhou. These findings also suggest that understanding the meanings that people assign to their sexual relationships is necessary to develop a public health response.

Entertainment venues played an important role in facilitating unprotected YYQ encounters. However, in a recent study in Liuzhou (³⁹) only 4% of venues were found to provide condoms. The Chinese government aims for 90% condom coverage in all hotels by the end of 2012, but has no clear plans for providing condoms in venues. Increasing condom availability and uptake in venues would facilitate the prevention of STI/HIV transmission with any sexual partner of unknown STI/HIV status, especially given the potential for sex acts to occur during or shortly after visiting these venues. Despite the protection that condoms provide, we found very few reports of participants using condoms during YYQ. Participants identified the importance of using condoms with commercial sex partners, but not in non-commercial YYQ; and many male participants reported disliking condoms because they detract from enjoying sex.

Our findings suggest, however, that improving the availability of condoms in venues is far from enough. STI/HIV prevention campaigns should target people’s perceptions of risk with YYQ partners, especially by challenging beliefs that building trust through social connections and socializing at venues is adequate for preventing STI/HIV. Trust, in many settings, inhibits condom use (⁴⁰). This is confirmed in our study, which demonstrates how people subjectively construct YYQ partnerships, using trust as a means to protect themselves rather than using condoms. To increase the uptake of condoms in YYQ relationships, campaigns need to build awareness of the importance of using condoms with any new partner of unknown STI/HIV status, regardless of how well the person is trusted and known in a shared social network.