The interface between sexuality and HIV: The problems and resilience of Chinese men

While HIV-infected gay and bisexual men in China experienced the negative impacts of their intersecting identities—particularly in terms of stigma—they also described how their identities helped them achieve unexpected successes, according to a recent qualitative study.

background

Gay and bisexual men in China continue to face discrimination based largely on the stigmatization of people from sexual minorities. In fact, homosexuality was only removed from the Chinese Classification of Mental Disorders (CCMS-3) in 2000. HIV rates remain disproportionately high in this population, adding additional stigma to an already ostracized group. Stigmatization of HIV-affected communities creates additional barriers to testing and treatment and reduces the quality of life of people living with HIV.

Intersectionality has become an important framework in health research in recent years. This approach advises against simply combining different identity markers to create increased vulnerability. Instead, the focus is on understanding intertwined webs of oppression and how the intersection of different marginalized identities (such as homosexuality) And Living with HIV can create unique realities that bring with them particular challenges and forms of resilience.

The study

Researchers from the City University of Hong Kong surveyed 21 gay and bisexual men living with HIV in Shenzhen (an affluent and inclusive city in southern China) in 2021. The men were between 21 and 56 years old, most identified as gay (86%), the rest as bisexual. Most had never been married, although two were divorced. More than half had been diagnosed with HIV for over three years and had started antiretroviral therapy at least a year before the study (81%). Most men had completed secondary education (62%), while one-third had completed tertiary education. Most men were employed (72%), with just over half employed full-time. About two-thirds of the sample reported having a stable monthly income.

The semi-structured interviews explored living with dual minority identities: being both gay and bisexual and living with HIV. While some questions focused on the challenges related to these identities, participants also had the opportunity to share positive experiences related to these identities. Interviews were conducted in Mandarin and translated into English during the data analysis process.

The interaction between sexuality and HIV

For some participants, the shame they felt about their homosexuality was compounded by the presence of HIV. In this sense, the synergistic effects were worse:

“When I was diagnosed with HIV, I thought: I hated myself for being gay. (I thought) If I wasn’t gay, I wouldn’t have been infected in the first place.”

One participant spoke about the practice of asking potential sexual partners to take an HIV test before sex – a practice that has become increasingly common in Shenzhen due to the high rate of HIV transmission among gay men. He spoke about how stigmatizing and an invasion of privacy this is:

“Nowadays, many people do the (quick) blood test at home. They usually do it before having sex. From my point of view, I can accept that someone will not have sex with me. (if I don’t test)but I feel my privacy is violated when they ask me to take a test.”

However, the researchers also describe “mitigating” effects – where the combination of sexuality and HIV led to positive outcomes that would not have occurred otherwise. This mainly concerned the social support that resulted from an HIV diagnosis:

“After I founded ART, I took part in (some of the) Activities organized by the Centers for Disease Control (CDC). I think they are good and necessary. They have given me psychological support that has helped me adapt to the situation.”

For some, homosexuality gave them the resilience they needed to deal with HIV. When asked if homosexuality helped them deal with HIV, this participant replied:

“Yes, I am stronger. I tell myself that I need to adjust my mindset when I get into situations where I am stuck with negative emotions and cannot move forward.”

Pressure and worries

The men’s overlapping identities created unique pressures and concerns. In terms of family expectations, marriage and continuing the family line were the biggest concerns. This was highlighted as a central aspect of Chinese culture:

“For me it is a tradition to pass on to the family. When I (was) not infected with HIV, I would definitely marry (and have children). Especially when you are in your mid-twenties, your parents will pressure you to go on blind dates. (Even) Although I know that I like people of the same sex, I go on such blind dates once or twice a year. However, after my diagnosis, I was hesitant to (with) these blind dates.”

However, some participants also described a sense of relaxation when their family learned that they were living with HIV:

“I had already told them about my HIV status and I think there is no need to tell them about my homosexuality. Since I am HIV positive, I do not have to get married…”

Men expressed concerns about their financial security in old age, especially since they had no children to care for them. Several feared losing their jobs due to discrimination or failing a medical exam at work, which would impact their health insurance and access to healthcare.

Distress and resilience

The fact that a high level of expected stigmatization is to be expected was shown by the fact that some men ended friendships preventively:

“I would discriminate against HIV-positive people if I were not infected myself. That is why I rarely contact other (Friends) now. I used to have several good friends. Last year, after I was diagnosed, I declined their invitation(S) five or six times together. They thought it was weird, but from my point of view, I wasn’t ready to contact them. I thought I was different from them.”

However, HIV also gave some men a boost of resilience. While they recognized the challenges associated with the diagnosis, they also gained new strength. This man started antiretroviral therapy in 2019:

“I have attempted suicide. In 2018, I was in hospital due to complications (out of) HIV and almost lost my life. I have been through so much (through) these years and survived. Now I believe that everything will pass and I am enjoying the moment.”

Diploma

“By integrating an intersectional framework with an empowerment-based perspective, our study approach enables us to provide useful insights into future priorities in HIV prevention and mental health promotion,” the researchers conclude. “Based on our findings, programs that address intersectional stigma while building resilience, thereby promoting mental health and physical well-being, are likely to be effective among sexual minority men living with HIV in urban areas of China.”